HDL cholesterol is not causally linked to heart disease, but low levels are associated with increased cardiovascular risk. While low HDL is a marker for ASCVD risk, very high levels can also raise the risk of mortality. Therapies to raise HDL levels have not been shown to reduce cardiovascular events. Additionally, a study testing the hypothesis that improving HDL function would improve outcomes did not show any benefit. Therefore, HDL is best considered a biomarker or risk-enhancing factor rather than a direct causal factor in heart disease, and may be used to identify individuals who may benefit from preventive therapies.
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HDL cholesterol as a biomarker or risk-enhancer
