A 33-year-old man has a low HDL level. Should you treat him?

Author: V. Dimov, M.D., Cleveland Clinic
Reviewer: A. Aneja, M.D., Cleveland Clinic

A 33-year-old male had a fasting lipid profile as a part of his regular screening.

Past medical history (PMH) and family medical history (FMH)

Negative.

Medications

None.

Fasting lipid profile

Triglycerides 100 mg/dL

Total cholesterol 192 mg/dL
HDL 36 mg/dL
LDL 136 mg/dL

What is abnormal?

HDL is low.
LDL is mildly elevated.

Should you treat an isolated low HDL level?

No medications are recommended.

Drug therapy is advised in patients with low HDL if the 10-year Framingham risk score is more than 20% or if the patient has a significant FMH of early CAD. ATP III provides a free online calculator of Framingham risk score.

What is treatment for low HDL?

Statins are often used but they cause only a modest increase in HDL level by 5-10%. Niacin is more potent (30% HDL increase) but less well tolerated than statins (90% of patients complain of flushing).

What lifestyle interventions can raise HDL?

Aerobic exercise can raise HDL level by 10%-20%. Daily alcohol consumption raises HDL level by 5-10%.

Weight loss does not always have a positive short term affect on lipid levels. For each kilogram of weight lost during active dieting, HDL levels falls by 8%. Once weight is stabilized, there is a mild increase in HDL.

Why is HDL cardioprotective?

HDL participates in moving cholesterol from peripheral tissue to the liver. It also has an antioxidant effect.

References

CHD Risk and Isolated Low HDL Cholesterol Levels. Am Fam Phys, August 15, 2000.
Raising an isolated low HDL-C level: Why, how, and when? (PDF). CCJM, 2003.
Low HDL Cholesterol (Hypoalphalipoproteinemia). eMedicine.
Approach to the Patient With low HDL Cholesterol: an Independent Risk Factor Cardiovascular Disease. Resident and Staff Physician, 04/2007.

Related Reading

Health: Nothing but a number: Lifestyle changes to control cholesterol. Dr. Sidney Gottlieb, Cleveland Clinic Canada, National Post, 01/2008.

New Blood Test Warns of Heart Disease: Lp-PLA2 Test Spots Heart Risk in Seemingly Healthy Seniors. Daniel J. DeNoon. WebMD Medical News, 02/2008.
Obama’s health by the numbers. Paging Dr. Gupta, 06/2008.
Low HDL Linked to Memory Loss. WebMD, 06/2008
Measuring hsCRP—An Important Part of a Comprehensive Risk Profile or a Clinically Redundant Practice? PLoS Medicine, 2010.
Monounsaturated fats found in vegetable oils, nuts and avocados increase "good" HDL cholesterol levels by 12% http://goo.gl/GBQa5

Published: 09/21/2006
Updated: 11/03/2010

4 comments:

  1. I got them

    PMH = Past Medical History
    PFH = Past Familu History
    CAD = Coronary Disease

    Right?

    ReplyDelete
  2. What is his ultra sensitive-CPR level?

    ReplyDelete
  3. While I agree that current medicine says "do nothing", the patient may have a family history of heart disease (and may not even be aware of it). As a former patient who had an MI brought about by low HDL (28), I can tell you that in my case the increase in HDL from exercise and Simvastatin was minimal. However, the addition of 2.5 - 3.0g/day Omega-3 and, most importantly, 2,000 IU/day Vitamin D has raised my HDL to 52, without regular exercise. (There are countless additional health benefits from exercise, but I'm a slacker. The point is, it has not had a large impact on my HDL.)

    ReplyDelete