The role of low- and high-density lipoprotein profiles in acute coronary syndrome

Abstract

Acute coronary syndrome (ACS) represents the most severe manifestation of ischaemic heart disease and remains a leading cause of cardiac mortality, carrying a particularly significant and growing burden in Indonesia, where regional prevalence continues to exceed the national average. Dyslipidemia, specifically elevated low-density lipoprotein cholesterol (LDL-C) and reduced high-density lipoprotein cholesterol (HDL-C), is among the most critical modifiable risk factors for the atherosclerotic process that underlies ACS, yet the holistic preventive significance of managing both lipid fractions simultaneously remains underemphasized in clinical practice. This narrative review synthesizes current evidence on the atherogenic role of LDL-C, the cardioprotective function of HDL-C, their combined and interactive contribution to coronary risk, and lifestyle-based preventive strategies that can favorably modify both parameters. The evidence reviewed demonstrates that elevated LDL-C and low HDL-C operate through distinct yet complementary pathways, lipid deposition and oxidative plaque destabilization on one hand, and loss of reverse cholesterol transport and endothelial protection on the other, and that their coexistence compounds atherogenic risk disproportionately. A holistic preventive approach integrating dietary modification, regular physical activity, smoking cessation, and weight management is proposed as the most sustainable strategy for simultaneously addressing both lipid abnormalities and reducing the burden of ACS at the individual and population level.