Managing dyslipidemia in Turkey: suggested guidelines for a population characterized by low levels of high density lipoprotein cholesterol

Anadolu Kardiyol Derg. 2002 Dec;2(4):315-22.


Based on data from the Turkish Society of Cardiology and others, it is established that Turks have a high prevalence of coronary heart disease (CHD). Several risk factors are prominent in Turks: dyslipidemia, cigarette smoking, and hypertension. The dyslipidemia is unique in that very low levels of HDL-C and typically "normal" LDL-C levels characterize the Turkish population. The low HDL-C levels appear to be genetic in origin and are largely independent of high triglyceride levels (73% of Turkish men and 94% of women with HDL-C <40 mg/dl have triglyceride levels <150 mg/dl; only 15% of men and 3% of women with HDL-C <40 mg/dl have triglyceride levels >200 mg/dl). HDL-C levels are 10-15% mg/dl lower in Turks than seen in the United States or western Europe. Low HDL-C is a major risk factor; CHD risk increases 2-4% for every 1 mg/dl decrease in HDL-C levels. Existing treatment guidelines focus on plasma LDL-C levels and fail to take into account the continuous increase in CHD risk that occurs as HDL-C levels decrease. However, several studies show that patients with CHD or free of CHD but with multiple risk factors, who have low HDL-C and near optimal LDL-C, benefit very significantly from lipid-lowering therapy. Many of these patients with low HDL-C levels do not qualify for drug therapy based on existing guidelines. Therefore, we believe that unique guidelines must be developed to guide the treatment of low HDL-C Turkish patients. We suggest that treatment based on both the LDL-C level and the total cholesterol/HDL-C (TC/HDL-C) ratio is the best way to address treatment of patients with low HDL-C levels. The most effective drug treatment available presently in Turkey relies on lowering LDL-C levels to optimize the TC/HDL-C ratio.

Publication types

  • Review

MeSH terms

  • Cholesterol / blood
  • Cholesterol, HDL / blood*
  • Coronary Disease / epidemiology
  • Coronary Disease / etiology
  • Coronary Disease / genetics
  • Coronary Disease / prevention & control*
  • European Continental Ancestry Group
  • Female
  • Humans
  • Hyperlipidemias / complications
  • Hyperlipidemias / epidemiology
  • Hyperlipidemias / genetics
  • Hyperlipidemias / prevention & control*
  • Hypertension / complications
  • Male
  • Practice Guidelines as Topic*
  • Risk Factors
  • Smoking / adverse effects
  • Triglycerides / blood
  • Turkey / epidemiology


  • Cholesterol, HDL
  • Triglycerides
  • Cholesterol