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HDL cholesterol: Clinical aspects of abnormal values

Robert S Rosenson, MD
Paul Durrington, MD
Section Editor
Mason W Freeman, MD
Deputy Editors
Howard Libman, MD, FACP
Gordon M Saperia, MD, FACC


High-density lipoprotein (HDL) cholesterol is a biomarker inversely associated with an increased risk of coronary heart disease (CHD) events. It is of considerable use in assessing patients’ coronary artery disease risk. However, low levels of HDL cholesterol have not been established as causative of this increase in risk. (See 'Low HDL cholesterol as a CVD risk factor' below and 'Effect of increasing HDL cholesterol on clinical outcome' below.)

This topic will address clinical aspects of abnormal HDL (the particle) and HDL cholesterol. A more detailed discussion of the role of HDL in cholesterol metabolism is found elsewhere. (See "Lipoprotein classification, metabolism, and role in atherosclerosis", section on 'High density lipoprotein'.)


High-density lipoprotein (HDL) is a complex circulating particle with many subspecies that vary in lipid and protein composition [1]. (See "Lipoprotein classification, metabolism, and role in atherosclerosis", section on 'High density lipoprotein'.)

Cholesterol is a major component of the particle and the amount of cholesterol contained in HDL particles can be directly measured; it is referred to as HDL cholesterol. In clinical practice, HDL cholesterol, rather than HDL, is used to risk stratify patients. (See "Measurement of blood lipids and lipoproteins", section on 'Total and HDL cholesterol'.)


The incidence of coronary heart disease (CHD) events in a multiple diverse population studies has been found to be inversely related to the serum high-density lipoprotein (HDL) cholesterol concentration, with low levels being associated with increased coronary risk (figure 1) [2-5]. Based on data from the Framingham Heart Study, the risk for myocardial infarction increases by about 25 percent for every 5 mg/dL (0.13 mmol/L) decrement in serum HDL cholesterol below median values for men and women [2]. Most of these studies have found that, after adjustment for other known risk factors, a low level of HDL cholesterol is an independent predictor of risk. This does not mean, however, that it is causative of CHD. (See 'Low HDL cholesterol as a cause of CVD events' below.)

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Literature review current through: Dec 2017. | This topic last updated: Oct 11, 2017.
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