Protective HDL Cholesterol on Healthy Endothelial Glycocalyx

HDL Cholesterol: Is the 'Good' Cholesterol Really Protective?

Lena Voss in Health & Wellness December 2025 • 4 min read.

"New research explores the surprising role of HDL cholesterol in endothelial health, especially for those managing hypertension."

Arterial hypertension, a major risk factor for cardiovascular disease (CVD), often leads to subtle damage in the body long before it's detectable. This 'target organ damage' (TOD) marks an intermediate stage in the development of CVD. It's crucial to identify and manage these early signs to prevent further progression.

One such area of focus is the endothelial glycocalyx (EG), a delicate layer lining blood vessels. A healthy EG is vital for maintaining vascular permeability, reducing inflammation, and ensuring elasticity. When the EG is compromised, it can contribute to cardiovascular problems.

High-density lipoprotein cholesterol (HDL-C) has traditionally been considered a protective factor against CVD. However, some research suggests that extremely high levels of HDL-C may not always be beneficial. This article explores the complex relationship between HDL-C levels and endothelial health, particularly in treated hypertensive patients, shedding light on whether higher HDL-C truly translates to better cardiovascular protection.

Unpacking the HDL Paradox: What the Research Reveals

Protective HDL Cholesterol on Healthy Endothelial Glycocalyx

A recent study investigated the role of increased HDL cholesterol levels in endothelial glycocalyx integrity in older hypertensive patients. Researchers divided 120 treated hypertensive patients (over 50 years old) into two groups based on their HDL-C levels: a high HDL-C group (HDL-C ≥ 71 mg/dL) and a lower HDL-C group (HDL-C < 71 mg/dL).

The study focused on measuring the perfusion boundary region (PBR) of sublingual arterial microvessels, a non-invasive method of assessing EG thickness. A lower PBR indicates a healthier, more intact glycocalyx, while a higher PBR suggests damage or thinning of this protective layer.

Key Finding: The high HDL-C group (HDL-C ≥ 71 mg/dL) exhibited a significantly decreased PBR, suggesting better endothelial glycocalyx integrity compared to the lower HDL-C group.
Correlation: In the entire study population, HDL-C levels were found to be inversely related to PBR, meaning higher HDL-C was associated with a healthier EG.
BMI's Role: Interestingly, Body Mass Index (BMI) independently predicted PBR, highlighting the impact of overall health and weight on endothelial function.

These findings suggest that in older hypertensive patients, moderately high HDL-C levels (between 71 and 101 mg/dL) might offer protection to the endothelial glycocalyx and, consequently, support endothelial function. However, the study also points to the complexity of HDL's role, suggesting that extremely elevated levels might not always translate to additional benefits.

The Future of HDL Research: What's Next?

This research underscores the need for further investigation into the optimal range of HDL-C for cardiovascular protection, especially in specific populations like those with hypertension. Future studies should focus on evaluating the potential benefits and risks associated with extremely elevated HDL-C levels.

It's important to remember that cardiovascular health is multifaceted, and HDL-C is just one piece of the puzzle. Maintaining a healthy weight, managing blood pressure, and avoiding smoking are crucial for overall cardiovascular well-being.

While HDL cholesterol remains an important marker, it's clear that we need a more nuanced understanding of its role in cardiovascular health. This research highlights the importance of personalized approaches to managing cholesterol and promoting endothelial health, considering individual risk factors and overall health status.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/jch.13404, Alternate LINK

Title: Hdl Cholesterol Levels And Endothelial Glycocalyx Integrity In Treated Hypertensive Patients

Subject: Cardiology and Cardiovascular Medicine

Journal: The Journal of Clinical Hypertension

Publisher: Wiley

Authors: Helen Triantafyllidi, Dimitris Benas, Stefanos Vlachos, Dimitris Vlastos, George Pavlidis, Antonios Schoinas, Mary Varoudi, Dionysia Birmpa, Paraskevi Moutsatsou, John Lekakis, Ignatios Ikonomidis

Published: 2018-10-13

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Everything You Need To Know

1

What is the main focus regarding HDL cholesterol, and what is the significance in relation to the human body?

High-density lipoprotein cholesterol (HDL-C) has long been regarded as 'good' cholesterol, playing a protective role in cardiovascular health. However, this understanding is evolving. Studies are examining the impact of various HDL-C levels, especially in individuals with arterial hypertension, a major risk factor for cardiovascular disease. The article focuses on the complex relationship between HDL-C and endothelial health, specifically the endothelial glycocalyx (EG), a vital layer in blood vessels. The goal is to determine if higher HDL-C translates to better protection in those with hypertension.

2

What is the endothelial glycocalyx (EG), and why is it important?

The endothelial glycocalyx (EG) is a delicate layer that lines blood vessels, critical for maintaining vascular health. A healthy EG ensures vascular permeability, reduces inflammation, and promotes elasticity. Damage or thinning of the EG can contribute to cardiovascular problems. The research highlights the EG as a key area of focus because its integrity is crucial for early detection and management of cardiovascular disease, particularly in those with arterial hypertension. The study uses the perfusion boundary region (PBR) to measure EG thickness, where a lower PBR indicates a healthier EG.

3

How does arterial hypertension relate to cardiovascular health?

Arterial hypertension is a major risk factor for cardiovascular disease (CVD). It often causes subtle damage to the body, known as 'target organ damage' (TOD), which is an intermediate stage in the development of CVD. It is important to identify and manage these early signs to prevent the progression of CVD. The article explores how HDL-C levels relate to endothelial health in treated hypertensive patients, shedding light on how HDL-C impacts the prevention of cardiovascular issues related to hypertension.

4

What were the key findings of the study about HDL cholesterol levels and endothelial health?

The recent study divided treated hypertensive patients into a high HDL-C group (HDL-C ≥ 71 mg/dL) and a lower HDL-C group (HDL-C < 71 mg/dL). The high HDL-C group showed a significantly decreased PBR, indicating better endothelial glycocalyx integrity. Moreover, higher HDL-C levels were inversely related to PBR in the entire study population. Interestingly, Body Mass Index (BMI) also independently predicted PBR. These findings suggest that moderately high HDL-C levels, between 71 and 101 mg/dL, could offer protection to the endothelial glycocalyx, potentially supporting endothelial function, particularly in older hypertensive patients.

5

What direction does future research need to take to better understand the role of HDL cholesterol?

The future of HDL research involves further investigation into the optimal range of HDL-C for cardiovascular protection, particularly in individuals with hypertension. The research underscores the need to evaluate the potential benefits and risks associated with extremely elevated HDL-C levels. Understanding this complex relationship will help to develop more targeted strategies for preventing and managing cardiovascular diseases, offering insights into the role of HDL-C and its impact on endothelial health and the prevention of diseases associated with arterial hypertension.