Hormonal
Obesity causes a shift in HDL subclass distribution from large, protective HDL2 particles to small, dense HDL3 particles, and impairs HDL functionality, including reduced cholesterol efflux capacity and anti-inflammatory properties.
Obesity doesn't just lower your HDL cholesterol number; it makes the HDL you have less effective at protecting your heart. This happens because excess fat increases enzymes that break down HDL and reduces protective proteins like adiponectin. To counter this, focus on weight loss and reducing inflammation, as these changes can restore HDL function and shift the balance back to more protective HDL particles.
In obese study participants, a shift from large HDL toward increased levels of intermediate and small HDL subclasses was seen... An increased CETP-mediated transfer of triglycerides on HDL and the subsequent hydrolysis of triglyceride-enriched HDL by hepatic lipase appeared to be the mechanism underlying the shift of large HDL to small and dense HDL particles... A reduction of the overall capacity of HDL to promote cholesterol efflux from fibroblasts in obese, compared to lean, normal-weight, subjects was reported
Why this rating
Based on multiple observational and interventional studies cited in the review, including the STAMPEDE trial substudy.
Source
Obesity-Related Changes in High-Density Lipoprotein Metabolism and Function
Julia T. Stadler et al. · International Journal of Molecular Sciences · 2020
DOI 10.3390/ijms21238985
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