Low Levels of High-Density Lipoprotein Cholesterol (Hypoalphalipoproteinemia)

Abstract

Clinical management of dyslipidemias has focused primarily on the low-density lipoprotein cholesterol (LDL-C) fraction; however, lipid disorders accompanied by low levels of high-density lipoprotein cholesterol (HDL-C) (hypoalphalipoproteinemia) are common, particularly among subjects with the diagnosis of coronary artery disease prior to age 55 years. The therapeutic objectives for high-risk subjects with dyslipidemias is directed initially toward reduction of the LDL-C fraction; thereafter, aggressive efforts aimed at raising the HDL-C fraction may be warranted. Strategies for raising the HDL-C fraction start with hygienic measures that include aerobic exercise, weight loss, smoking cessation, withdrawal of agents secondarily lowering HDL-C, and estrogen replacement. Pharmacotherapy selected according to the dyslipidemia that accompanies the HDL-C disorder is indicated for subjects who manifest premature coronary artery disease or who have a familial history of coronary artery disease and hypoalphalipoproteinemia.

New Perspectives on the Management of Low Levels of High-Density Lipoprotein Cholesterol

“…Acute illnesses such as a myocardial infarction, burns, surgical procedures, acute viral illness, or any inflammatory condition that results in an acute phase response will alter lipid levels. 25 Typically, the total cholesterol, LDL-C, and HDL-C levels will decrease while triglyceride levels increase. Two to 5 days after a myocardial infarction, HDL-C levels start to decrease.…”

“…Lipid measurement should not be performed within 60 days of a myocardial infarction or major surgical procedure. 25 The contribution of other chronic diseases also needs to be considered. The most common secondary causes of altered lipids include hypothyroidism, diabetes, uremia, and liver disease.…”

“…Adverse effects include increased liver enzyme levels, dyspepsia, and myopathy. 25 Preliminary data from several primary and secondary CHD prevention trials suggest that HMG-CoA reductase inhibitors may reduce the adverse consequences of low HDL-C levels and result in significant morbidity and mortality reductions. For example, in the land-mark HMG-CoA reductase inhibitor trials, such as the Scandinavian Simvastatin Survival Study, the West of Scotland Coronary Prevention Study, and the Cholesterol and Recurrent Events study, subgroup analysis of those with low HDL-C levels but with elevated LDL-C levels demonstrated similar CHD risk reductions compared with those with normal HDL-C levels.…”

Elevated total cholesterol in bulimia nervosa

“…Again, the differences across diagnostic groups were statistically significant. High-density lipoprotein-cholesterol (HDL-c) (Rosenson, 1993) or low-density lipoprotein-cholesterol (LDL-c) (The National Cholesterol Education Program Expert Panel, 1988) may better predict coronary heart disease risk than total cholesterol concentrations. …”