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In Search of the Ideal Measure of High-Density Lipoprotein

The Mary Imogene Bassett Hospital, Cooperstown, NY 13326, Fax 607-547-3061, E-mail rreed@usa.net

Measurement of any heterogeneous substance poses a challenge. HDL-cholesterol (HDL-C) is no exception. Numerous methods, based on different principles, have been widely adopted and these different methods often give significantly different values for HDL-C. The paper of Okazaki et al. (1), in this issue, demonstrates the inadequacy of a phosphotungstate precipitation method for HDL-C and proposes the use of HPLC as a tool to compare analytical methods for HDL-C.

Interest in developing and evaluating methods for the measurement of HDL-C has origins in two separate arenas—one clinical, reflecting increased attention to HDL-C as a risk factor for coronary heart disease (CHD), and the other economic, reflecting increased emphasis on finding more-cost-effective ways to measure HDL-C.

Although HDL-C has long been recognized as a factor in the development of CHD, it has not received nearly the attention given to LDL-cholesterol. Much of the primary and secondary prevention effort is based on risk as defined by LDL-cholesterol. Treatment is targeted at reducing LDL-cholesterol, and success of therapies is judged by their impact on LDL-cholesterol. Nevertheless, in many studies, HDL-C has been shown to be a stronger predictor of risk of CHD than LDL-cholesterol. For example, in the Framingham Heart Study, a 1% increase in LDL-cholesterol translated to a 2% increase in risk, whereas a 1% decrease in HDL-C translated into a 3–4% increase in risk (2). In the Helsinki Heart Study, in those subjects with high LDL-cholesterol (Frederickson Type IIa hyperlipidemia), the greatest predictive value for CHD was low HDL-C, not the severity of the LDL-cholesterol increase (3). In a review of nine different prospective studies in women, HDL cholesterol emerged as the single most important lipid risk factor in women (4).

Recently, the National Cholesterol Education Panel released the . . . [Full Text of this Article]

References

The following articles in journals at HighWire Press have cited this article:

				G. R. Warnick, M. Nauck, and N. Rifai Evolution of Methods for Measurement of HDL-Cholesterol: From Ultracentrifugation to Homogeneous Assays Clin. Chem., September 1, 2001; 47(9): 1579 - 1596. [Abstract] [Full Text] [PDF]

				J. C. Escola-Gil, O. Jorba, J. Julve-Gil, F. Gonzalez-Sastre, J. Ordonez-Llanos, and F. Blanco-Vaca Pitfalls of Direct HDL-Cholesterol Measurements in Mouse Models of Hyperlipidemia and Atherosclerosis Clin. Chem., September 1, 1999; 45(9): 1567 - 1569. [Full Text] [PDF]

				J. Camps, J. M. Simo, S. Guaita, N. Ferre, and J. Joven Altered Composition of Lipoproteins in Liver Cirrhosis Compromises Three Homogeneous Methods for HDL-Cholesterol Clin. Chem., May 1, 1999; 45(5): 685 - 688. [Full Text] [PDF]

				J. M a Simo, I. Castellano, N. Ferre, J. Joven, and J. Camps Evaluation of a homogeneous assay for high-density lipoprotein cholesterol: limitations in patients with cardiovascular, renal, and hepatic disorders Clin. Chem., June 1, 1998; 44(6): 1233 - 1241. [Abstract] [Full Text] [PDF]

				T. Delahunty Early Historical Milestones in HDL-Cholesterol Assay Clin. Chem., April 1, 1998; 44(4): 898 - 899. [Full Text] [PDF]