Feature Article

The ABC of HDL: a paradigm shift in managing lipid disorders

Gerald Watts, John R Burnett
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There has been renewed interest in the protective role of high density lipoprotein (HDL) against atherosclerosis and coronary heart disease (CHD), chiefly owing to new research showing that raising HDL may diminish the risk of clinical cardiovascular events. The burgeoning body of work on HDL is rapidly generating a new paradigm for the management of lipid disorders in clinical practice.

Key Points

  • The antiatherogenic effect of HDL is mediated by both enhanced reverse cholesterol transport and direct mechanisms on the arterial wall.
  • The first approach to raising HDL-cholesterol is to identify the cause of a low level.
  • Correcting hypertriglyceridaemia usually increases low HDL-cholesterol, but specific elevation in HDL-cholesterol may be needed in some patients.
  • Lifestyle modifications should aim to improve body weight and insulin resistance in obese subjects.
  • Drugs are often needed to optimise the lipid profile and elevate HDL-cholesterol.
  • Patients taking statins will often require adjunctive therapy, such as gemfibrozil, fenofibrate or fish oil, to raise HDL-cholesterol.
  • In patients with type 2 diabetes or the metabolic syndrome, plasma HDL-cholesterol should be raised above 1.2 mmol/L.