Further proof of a paradoxical relationship between high-density lipoprotein levels and adverse cardiovascular outcomes - Are there implications for cardiovascular disease prevention?

Cardiovascular disease (CVD), mainly coronary heart disease, persists as the leading cause of disease burden and deaths in the world; in 2019, it was the cause of 6.2 million deaths among individuals between the ages of 30 and 70 years.1 Major cardiovascular risk factors include core health behaviours and health factors such as smoking, physical activity, diet, weight, lipids, blood pressure, and glucose control, which contribute to cardiovascular health.2 High systolic blood pressure and smoking were the first and second leading years of life lost (YLL) risk factors globally.2 The major lipids that are generally accepted as risk factors for CVD include total cholesterol, LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and triglycerides.3 High LDL-C remains a major threat to public health, due to elevated CVD risk, and its overall burden in terms of mortality and YLLs is on the increase globally.1