High-density lipoproteincholesterol, reverse cholesterol transport, and cardiovascular risk: a tale of genetics?

  • Giovanni Cimmino Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Italy.
  • Chiara D’Amico Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Italy.
  • Giovanni Ciccarelli Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Italy.
  • Marco Golino Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Italy.
  • Alberto Morello Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Italy.
  • Saverio D’Elia Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Italy.
  • Valeria Marchese Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Italy.
  • Paolo Golino | paolo.golino@unina2.it Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, Second University of Naples, Italy.

Abstract

Cholesterol deposition plays a central role in atherogenesis. The accumulation of lipid material is the result of an imbalance between the influx and efflux of cholesterol within the arterial wall. High levels of plasma low-density lipoprotein-cholesterol are considered the major mechanism responsible for the influx and accumulation of cholesterol in the arterial wall, while high-density lipoprotein (HDL)- cholesterol seems responsible for its efflux. The mechanism by which cholesterol is removed from extra-hepatic organs and delivered to the liver for its catabolism and excretion is called reverse cholesterol transport (RCT). Epidemiological evidence has associated high levels of HDL-cholesterol/ApoA-I with protection against atherosclerotic disease, but the ultimate mechanism(s) responsible for the beneficial effect is not well established. HDLs are synthesized by the liver and small intestine and released to the circulation as a lipid-poor HDL (nascent HDL), mostly formed by ApoA-I and phospholipids. Through their metabolic maturation, HDLs interact with the ABCA1 receptor in the macrophage surface increasing their lipid content by taking phospholipids and cholesterol from macrophages becoming mature HDL. The cholesterol of the HDLs is transported to the liver, via the scavenger receptor class B, type I, for further metabolization and excretion to the intestines in the form of bile acids and cholesterol, completing the process of RCT. It is clear that an inherited mutation or acquired abnormality in any of the key players in RCT mat affect the atherosclerotic process.

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Published
2013-10-15
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Section
Review Articles
Keywords:
atherosclerosis, high-density lipoproteins, low-density lipoproteins, reverse cholesterol transport.
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How to Cite
Cimmino, G., D’Amico, C., Ciccarelli, G., Golino, M., Morello, A., D’Elia, S., Marchese, V., & Golino, P. (2013). High-density lipoproteincholesterol, reverse cholesterol transport, and cardiovascular risk: a tale of genetics?. Cardiogenetics, 3(1), e7. https://doi.org/10.4081/cardiogenetics.2013.e7