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HDL-cholesterol: the negative risk factor for coronary heart disease.

High density lipoprotein cholesterol (HDL-cholesterol) has emerged as a negative risk factor for coronary heart disease. Humans with low levels of HDL-cholesterol are at greater risk of developing coronary heart disease whereas those with high levels are less prone. The epidemiological and biological evidence of this association are strong. As a predictor of coronary heart disease risk, HDL-cholesterol is independent of the other risk factors and is the most powerful lipid predictor. Both genetic and environmental factors influence the serum HDL-cholesterol level. Two physiological mechanisms may explain the presumed protective effect of HDL-cholesterol. However, controlled trials of intervention on the effect of rising HDL-cholesterol on coronary heart disease risk are not yet available. The physician is recommended to include HDL-cholesterol determination as part of his approach to the management of hyperlipoproteinemia. But he is cautioned against the pitfalls of methodology and data interpretation.