Update on Lipids and Lipoproteins—Reply
- 26 January 2021
- journal article
- letter
- Published by American Medical Association (AMA) in JAMA
- Vol. 325 (4), 400-401
- https://doi.org/10.1001/jama.2020.22624
Abstract
In Reply We agree with Drs Jialal and Devaraj that total cholesterol and HDL-C can be measured accurately and precisely in clinical laboratories, and that the difference, referred to as non–HDL-C, is a good measure of the total cholesterol content carried by circulating apoB-containing lipoproteins. However, our article did not focus on the best way to measure lipids in the laboratory.1 Furthermore, apoB is not a lipid, but instead is a lipoprotein that carries lipids in plasma. Conflating lipids measured in the standard lipid panel with lipoproteins is a common mistake that leads to confusion about the role of lipids and lipoproteins in the development of atherosclerotic cardiovascular disease (ASCVD). For example, both LDL and HDL carry cholesterol. However, increased LDL-C is associated with a higher risk of ASCVD, while increased HDL-C is associated with a lower risk.2 This observation leads to the notion that LDL somehow carries “bad” cholesterol, while HDL carries “good” cholesterol. There is in fact no difference between the cholesterol carried by LDL and HDL particles. Instead, LDL is an apoB-containing lipoprotein that can become trapped in the artery wall, leading to atherosclerosis, whereas HDL is an apolipoprotein A–containing lipoprotein that does not directly contribute to atherosclerotic plaque formation.3 Therefore, reducing LDL-C decreases the risk of cardiovascular events, while increasing HDL-C does not.4This publication has 5 references indexed in Scilit:
- Lipids and Lipoproteins in 2020JAMA, 2020
- 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular riskEuropean Heart Journal, 2019
- Faculty Opinions recommendation of Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel.Published by H1 Connect ,2019
- Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus PanelEuropean Heart Journal, 2017
- Major Lipids, Apolipoproteins, and Risk of Vascular DiseaseJAMA, 2009