Landmark Paper: HDL Indicates, HDL Efflux Capacity Dominates -

Thanks Rakesh Patel MD for sending this very recent paper on!

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1409065

- it begins to speak to the heart of the matter; basically HDL Efflux Capacity is showing up as a compelling part of minimizing atherosclerosis and CVD (btw Efflux is HDL particle mediated transport of lipid content out of the macrophage via ATP Binding Cassette mechanism ABCA1)

Notably, as always seen (unless one is on high strength lipid-lowering medication), HDL concentration is inversely linked to the extent of disease - but key is that the HDL efflux capacity is linked much more closely:

As can be seen, higher HDL indicates better function (see previous HDL posts).  BUT, high HDL Efflux Capacity has a stronger causal nature! And if you statistically back out HDL concentration, the Efflux Capability dominates.  So, as has been repeatedly proposed, HDL-C is an indicator of good function - but now it transpires why. The table below also illustrates the linkage:

And what approach promotes both? Why, Low Insulin / LCHF, that's what - see my next post for the most important factor of them all. Mortality curves for the HDL Efflux below - impressive: