What is the role of medications in the treatment of low HDL cholesterol (hypoalphalipoproteinemia)?

Updated: May 21, 2021
  • Author: Vibhuti N Singh, MD, MPH, FACC, FSCAI; Chief Editor: George T Griffing, MD  more...
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Answer

Currently, clinical trial results suggest that raising high-density lipoprotein (HDL) levels reduces risk. However, the evidence does not support a recommendation of therapy for hypoalphalipoproteinemia (HA). Additionally, drugs available for cholesterol management do not raise HDL cholesterol levels as much as desired. However, physicians should pay reasonable attention to low HDL cholesterol levels and their management.

According to NCEP ATP III guidelines, the primary goal of therapy is to lower low-density lipoprotein (LDL) cholesterol levels. [3, 4, 5, 6] Once the LDL target has been reached, emphasize therapeutic lifestyle changes, such as weight management and increased exercise, especially if the patient has a metabolic syndrome.

If triglyceride (TG) levels are lower than 200 mg/dL (ie, isolated HA), drugs for raising HDL (eg, fibrates, nicotinic acid) can be considered. Statins have only a modest effect. Treatment for isolated low HDL cholesterol levels is reserved mostly for individuals with established coronary heart disease (CHD) and for patients with risk factors for CHD.


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