New perspectives on the management of low levels of high-density lipoprotein cholesterol

A serum high-density lipoprotein cholesterol (HDL-C) level is a potent pred ictor of coronary heart disease (CHD), It has been estimated that 11% of US men have isolated low HDL-C levels, and there is uncertainty regarding the management of these patients. A cause-and-effect relationship between low HDL-C levels and CHD is supported by epidemiological, animal, and human cli nical studies. We reviewed the structure and function of HDL-C and its role in preventing atherosclerosis. We then suggested an approach to the patien t with isolated low HDL-C that may be useful to the primary care physician. An algorithm was proposed for use in patients with existing CHD, while the decision to treat patients without CHD was based on their score on the Fra mingham Heart Study risk prediction chart.