Why is there a focus on dysfunctional HDL? Well a lot of this interest started
as I'm not. As people noticed that HDL is far more important than LDL, I am
certainly not the first person to notice. That that's been known.
As usual I get some of the greatest suggestions from viewers and patients.
That this one is from Claudio Fossati. Claudio is saying, "Hi if you googled
dysfunctional HDL there's some interesting articles that seem serious
to me for what I can evaluate messing the picture concerning HDL role
but they are too difficult for me so I'm asking for a comment word by an expert."
Tom Deck had mentioned earlier, he asked about it earlier and Tom Deck had
mentioned that maybe there wasn't great science around that. There are some
really good science components to this question of dysfunctional HDL so I
thought it would I would take a few minutes to cover at least the image out
of one of the articles. But before I do I'll just make the comment
they've even taken well. First of all, why is there a focus on dysfunctional HDL?
Well a lot of this interest started as I'm not as people noticed that HDL is
far more important than LDL. I am certainly not the first person to notice
that that's been known. People that knew that have focused on doing some
interesting research. For example, taking pulling HDL out using for rhesus blood
filtering and actually taking that HDL and putting it into the blood through
the vein that's never worked. They've tried multiple times now, oh why hasn't
it worked. It's not entirely clear right now but there's the assessment that it
it or there's the several guesses. One of them is that there's too many things
piled on that HDL to where you can't really... it really can't form the particle
that it needs to form. I suspect there's a lot more to it than that.
There's also a very good article in NATURE magazine about it. It's a review of
HDL and HDL dysfunction. As part of that article, there's a great image here and I
just wanted to go over that image, just part of this discussion. What it
does is it helps you broaden your understanding of all of the different
functions of HDL. Yes Tom, we've covered them in several different videos but I
don't think we've ever had an image this good to help people understand all of
the things that HDL does. Once you begin to understand all of those different
components then it becomes clearer how there could be significant dysfunctions,
genetic and otherwise, within the HDL process. Now when you... when I mentioned
genetic dysfunctions in HDL and need to clarify something.
Remember genes are really something for proteins HDL is APOA1. The APOA1
protein and a bunch of cholesterol fat lipids. So if you're going to have a
genetic variation in HDL, it's going to be an APOA1 but again as you start
looking at the different functions that HDL plays you can begin to see yes if
there are genetic variations of APOA1 and there are then there very well
may be some issues around here in terms of dysfunctional HDL. While I'm speaking
on this topic, I just got to make one more comment and I believe it was HDL
Milano. I believe there's a genetic variation of HDL called HDL Milano
and again please check my facts on this. I'm drawing this out of something a long
time ago but I do believe there's a generic genetic variation called HDL
Milano. I do believe that it's therefore a variation in APOA1 and I believe
these people really lived a long time, maybe pushing a hundred years but again
I would love to see somebody fact check me on that and give us the real story.
Now just what I wanted to show you a minute
a visual about what all does HDL actually do. So as you may recognize this
there's a lot of diagrams that are very similar to this this is the endothelium
or the intima that single cell layer. This is the bloodstream with the red
cells floating around in it. These are monocytes coming in to deal
with this large plaque. This yellow thing under the intima is always always going
to be plaque when you talk about the stuff that I do so that's the - site
receptor so here here's a couple of other things to think about this is
gotta be 100 so this is LDL and it's getting pulled into the plaque well here
you send this is HDL here and it's coming into the plaque. It actually does
work inside the plaque so here's one place that it has an impact. HDL is
integral to getting the LDL out of the macrophage foam cell. You remember the
microphage cell is the cell that's gotten involved in trying to liquify
this plaque and it does that by releasing packets and pulling some of
these pieces of LDL into and the macrophage so the first place is helping
the foam cell rule or the macrophage release LDL. Here's another place where
HDL has a significant function. You follow this arrow over here and you see
it has a lot to do with oxidation. It actually slows down oxidation of LDL.
Remember that remember oxLDL you'll see that in a lot of the labs. OxLDL is
the part of the major part of the of the plaque itself and again HDL slows that
process down. Here's another place where HDL has an impact.
It's the adhesion mater molecules ICAM1 VCAM1. So again yet another function
for HDL. The final function and you clearly need
to know about this it may ring a bell for some of you
HDL is integral to the process of nitric oxide. Remember nitric oxide is maybe the
major determinants of health or maybe the major result of heart attack.
It's very much tied up with health of the intima... the intima lining. So multiple
places where HDL actually functions, both inside and outside of the plaque itself.
And oh yes I almost forgot it also does reverse transport. It takes that
cholesterol from LDL from out here peripherally back to the liver so it can
be metabolized and burned up. So again I'm not going to get any deeper than
that right now. Hopefully we'll be able to cover this more deep this article
more deeply and the whole concept of dysfunctional HDL. If you've made
it this far, thank you very much for your interest.
I wanted to remind you that if you'd like to get your CIMT, the first stop
on the CIMT Access tour is in Anaheim in LA on September 28. That's a half-day
of David Meinz talking about in person. How would we do these of what the
advantages are a little bit more about lifestyle and its impact on health. Todd
and I plan to come in remotely but the big thing here is getting that CIMT.
All of this is like I think 245 yeah 245 bucks to get a half day of this type of
information but more importantly a your own CIMT done and read. To get there
you go to CardioRisk.US/HealthyLife. Thank you.