A low level of circulating HDL-C represents a problem that is both common and clinically challenging. The National Cholesterol Treatment Panel recognizes the sex-specific cutoffs of HDL-C <40 mg/dL for men and <50 mg/dL for women as undesirable. Low HDL-C, linked to premature coronary artery disease, being identified with increasing frequency as lipid screening recommendations is increased. Epidemiological data indicate that a 1 mg/ dL increase in HDL-C would correlate to a 2% to 3% reduction in cardiovascular events, an impact greater than that noted for LDL-C. However, pharmacological interventions that raise HDL-C have not been clearly shown to reduce adverse cardiovascular outcomes. This conundrum has forced clinicians to reconsider existing and emerging data on HDL-C biology and therapeutic strategies to optimize clinical outcomes. Low HDL-C levels should prompt testing for secondary causes, some of which are reversible or artifactual. Statins remain the first-line therapy among individuals with low HDL-C levels and significant cardiovascular risk who warrant intervention, as defined by validated risk algorithms. Therapeutic lifestyle changes may offer general health benefits, including the possibility of improved HDL-C levels and functions. In terms of specific HDL-C-targeting therapies, fibrates may be reasonable to use in patients with significant cardiovascular risk, along with statins, if triglycerides are significantly elevated, eg, >200 mg/dL, and HDL-C is low. Niacin, still without a large clinical trial of its clinical effectiveness, but if tolerable, remains another theoretical option in patients with (1) substantially elevated lipoprotein(a), (2) statin intolerance, (3) in addition to statin therapy, in patients with isolated low HDL-C and progressive cardiovascular events.
|Number of pages||14|
|Journal||Journal of Internal Medicine of Taiwan|
|Publication status||Published - 2014 Dec 1|
All Science Journal Classification (ASJC) codes
- Internal Medicine