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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


Most trials of hypolipidemic therapy to prevent coronary heart disease (CHD) have evaluated therapies to lower low density lipoprotein (LDL) cholesterol. LDL-cholesterol lowering is associated with improvements in outcomes, particularly in trials of statin therapy, irrespective of whether it is attempted as primary or secondary prevention. (See "Clinical trials of cholesterol lowering for primary prevention of coronary heart disease" and "Clinical trials of cholesterol lowering in patients with cardiovascular disease or diabetes".)

The level of high density lipoprotein (HDL) cholesterol is inversely related to the presence or development of CHD, but a causal relationship between the cholesterol content in HDL particles (HDL-cholesterol) has not been established [1]. (See 'HDL-C and CVD risk' below.) In addition, the evidence that raising HDL-cholesterol is of benefit in reducing cardiovascular events has not been established. (See 'Effect of increasing HDL-C on clinical outcome' below.)

HDL-cholesterol concentrations are inversely associated with certain apolipoprotein B (apoB) containing lipoproteins (remnant particles, LDL particles) [2]. Thus, for individuals with low HDL-cholesterol, the first priority of treatment is attempting to lower these apoB-containing lipoproteins beginning with LDL-cholesterol using a statin [3].

This topic will address aspects of abnormal HDL; in particular, the relationship between HDL-cholesterol (HDL-C) to coronary risk, the role of dysfunctional HDL, and our approach to patients with low serum HDL-C levels will be discussed. The role of HDL in cholesterol metabolism is discussed separately. (See "Lipoprotein classification, metabolism, and role in atherosclerosis".)


There are a variety of different lipid disorders that can occur as either a primary event or secondary to some underlying disease. (See "Secondary causes of dyslipidemia".)


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