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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 Editor
Gordon M Saperia, MD, FACC


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

This topic will address clinical aspects of abnormal HDL (the particle) and HDL-C. 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' and "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 (HDL-C). In clinical practice, HDL-C, rather than HDL, is used to risk stratify patients. (See "Measurement of blood lipids and lipoproteins", section on 'Total and HDL-C'.)


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 cholesterol (HDL-C) 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-C below median values for men and women [2]. Most of these studies have found, after adjustment for other knows risk factors, a low level of HDL-C is an independent predictor of risk. This does not mean, however, that it is causative of CHD. (See 'Low HDL-C as a cause of CVD events' below.)


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