Role of HDL in Atherogenesis: Cholesterol and Atheroprotection

Atherosclerosis is a major global health burden, responsible for a significant proportion of cardiovascular morbidity and mortality worldwide. Its high prevalence and severe clinical consequences have made it a subject of extensive research. Despite considerable advances, the complexity of its pathogenesis continues to hinder the development of effective preventive strategies and therapeutic interventions. Current evidence implicates chronic inflammation, dysregulated lipid metabolism, cholesterol accumulation, and multiple atherogenic modifications of LDL particles as key drivers of atherogenesis. In contrast, lipids of the HDL class are widely recognized for their atheroprotective properties. In this review, we consolidate current data on the role of HDL in atherosclerosis, with particular focus on HDL-associated cholesterol (HDL-C) as a clinically and biologically relevant parameter.