Reverse cholesterol transport: High-density lipoprotein's magnificent mile

High-density lipoproteins (HDLs) are among the most structurally complex and functionally versatile forms of circulating serum lipoproteins. HDLs undergo extensive enzymatic remodeling during their maturation in serum, interact with highly specific receptors in peripheral tissues and the liver, and are able to exert a variety of antiatherogenic effects (eg, inhibit inflammation, oxidation, and apoptosis). Considerable epidemiologic, clinical, and basic scientific investigation supports the conclusion that HDLs as a molecular class are atheroprotective. One of the most important antiatherogenic functions of HDL is its capacity to drive reverse cholesterol transport, the process by which excess cholesterol in peripheral tissues is extracted and delivered to the liver for disposal. Despite the rapid expansion in our understanding of how HDL antagonizes many of mechanisms etiologic for atherosclerosis and the observation that a low serum level of HDL is the most frequent lipid abnormality in patients with premature coronary artery disease, many physicians still focus inadequate attention on recognizing and treating hypoalphalipoproteinemia. Our current understanding of reverse cholesterol transport reinforces the clinical importance of including HDL screening when evaluating any given patient's risk for cardiovascular disease. Copyright © 2003 by Current Science Inc.