SummarySeveral epidemiological studies reported an inverse relationship between plasma highdensity lipoprotein (HDL) cholesterol levels and atherosclerotic cardiovascular disease (ASCVD). However, therapeutic interventions targeted at raising HDL-cholesterol failed to improve cardiovascular outcomes, suggesting that HDL components distinct from cholesterol may account for the anti-atherothrombotic effects attributed to this lipoprotein. Sphingosine-1-phosphate (S1P) and the acute phase protein serum amyloid A (SAA) have been identified as integral constituents of HDL particles. Evidence suggests that S1P and SAA levels within HDL particles may be affected by inflammation and oxidative stress, which are coexisting processes underlying ASCVD. Because SAA, an inflammation-related marker, and S1P, an anti-atherothrombotic marker, have relatively clear opposite characteristics among the HDL-associated proteins, the approach of assessing the two markers simultaneously may provide new insights in clinical practice (S1P/SAA Index). This review focuses on evidence in support of the concept that the S1P/SAA Index may affect the HDL atheroprotective properties and may, therefore represent a potential target for therapeutic interventions.
K E Y W O R D Satherosclerotic cardiovascular disease, high-density lipoprotein, serum amyloid A, sphingosine- , showed that low HDL-cholesterol levels are an independent risk factor for ASCVD and estimated that an increase of 1 mg/dL (0.026 mmol/L) in HDLcholesterol is associated with a 2%-3% of risk reduction. 8,9 Further