High-density lipoprotein as a modulator of platelet and coagulation responses

Cardiovasc Res. 2014 Aug 1;103(3):362-71. doi: 10.1093/cvr/cvu137. Epub 2014 Jun 1.


Platelets and coagulation factors are involved in the process of haemostasis, which ensures undisturbed blood flow upon vessel wall damage. However, excessive platelet aggregation and/or coagulation may lead to arterial or venous thrombosis. Pro-atherogenic lipoproteins, including native and oxidized low-density lipoprotein (LDL), are associated with an increased susceptibility to thrombosis. In contrast, numerous epidemiological studies have established an inverse correlation between high-density lipoprotein (HDL) levels and the risk for thrombosis. In addition to its role in reverse cholesterol transport, HDL also interacts with platelets, the coagulation cascade, and the vascular endothelium. Native HDL prevents platelet hyperreactivity by limiting intraplatelet cholesterol overload, as well as by modulating platelet signalling pathways after binding platelet HDL receptors such as scavenger receptor class B type I (SR-BI) and apoER2'. The antithrombotic properties of native HDL are also related to the suppression of the coagulation cascade and stimulation of clot fibrinolysis. Furthermore, HDL stimulates the endothelial production of nitric oxide and prostacyclin, which are potent inhibitors of platelet activation. Thus, HDL's antithrombotic actions are multiple and therefore, raising HDL may be an important therapeutic strategy to reduce the risk of arterial and venous thrombosis.

Keywords: Arterial thrombosis; Coagulation; High-density lipoprotein; Platelets; Venous thrombosis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Arterial Occlusive Diseases / blood
  • Arterial Occlusive Diseases / etiology
  • Arterial Occlusive Diseases / prevention & control*
  • Blood Coagulation* / drug effects
  • Blood Platelets / drug effects
  • Blood Platelets / metabolism*
  • Endothelium, Vascular / metabolism
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Lipoproteins, HDL / blood*
  • Lipoproteins, HDL / chemistry
  • Lipoproteins, HDL / therapeutic use
  • Platelet Activation* / drug effects
  • Recombinant Proteins / therapeutic use
  • Risk Factors
  • Signal Transduction*
  • Thrombosis / blood
  • Thrombosis / etiology
  • Thrombosis / prevention & control*
  • Venous Thrombosis / blood
  • Venous Thrombosis / etiology
  • Venous Thrombosis / prevention & control*


  • Fibrinolytic Agents
  • Lipoproteins, HDL
  • Recombinant Proteins