コレステロール引き抜き能?その臨床的意義と課題?

摘要

Regarding the prevention of atherosclerotic diseases, epidemiological and observational studies have shown that the lower the blood level of LDL-C, the better. Intervention studies have shown that this is also true for the LDL-C level. Since low HDL-C levels have been reported to be a risk for atherosclerotic disease, it has been considered logical to increase HDL-C levels with the goal of counteracting the residual risk after LDL-C lowering therapy. However, higher blood levels of HDL-C are not necessarily better, and in patients already receiving LDL-C-lowering therapy, increasing HDL-C levels by treatment did not have a preventive effect against atherosclerosis. Therefore, HDL research has undergone a paradigm shift from "quantity to quality". With respect to HDL quality, the cholesterol efflux capacity has been noted as one of the measurable HDL functionalities. Many investigators, including ourselves, have reported that the cholesterol efflux capacity is a more useful surrogate marker of atherosclerosis than HDL-C levels. However, since measurement of the cholesterol efflux capacity cannot be standardized because of the use of cultured cells, it is difficult to use this method as a clinical test. In addition, the results obtained are not therapeutic targets because they are merely phenomena. In order to overcome the above issues, it is considered important to identify new substances that reduce the cholesterol efflux capacity and are elevated in patients with atherosclerotic diseases. Furthermore, rather than focusing simply on the increase or decrease in the cholesterol efflux capacity, research focusing on the biological roles of HDL, such as excretion of cellular excess cholesterol and transport of fat-soluble toxic substances, may be more essential. [Review]