The importance of recognizing and treating low levels of high-density lipoprotein cholesterol: a new era in atherosclerosis management

Rev Cardiovasc Med. 2008 Fall;9(4):239-58.


Low levels of high-density lipoprotein cholesterol (HDL-C) represent a major cardiovascular risk factor, with a stronger relationship to coronary heart disease than that seen with elevated levels of low-density lipoprotein cholesterol (LDL-C). HDL-C has important antiatherogenic effects, including reverse cholesterol transport, inhibition of LDL-C oxidation, and antiplatelet and anti-inflammatory actions. Patients with low HDL-C are also at an amplified risk of coronary heart disease due to the common coexistence of other risk factors, including excess adiposity, metabolic syndrome, type 2 diabetes mellitus, hypertriglyceridemia, and the atherogenic dyslipidemia characterized by small dense LDL-C. First-line therapy of low HDL-C generally consists of nonpharmacologic measures such as improved fitness and weight loss. Current pharmaceutical options include statins, fibrates, and nicotinic acid. A host of novel approaches involving HDL-C and reverse cholesterol transport hold the promise of fundamentally changing the natural history of atherosclerosis, the most common and important chronic disease in humans.

Publication types

  • Review

MeSH terms

  • Apolipoprotein A-I / therapeutic use
  • Atherosclerosis / blood
  • Atherosclerosis / etiology
  • Atherosclerosis / prevention & control*
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Cholesterol Ester Transfer Proteins / antagonists & inhibitors
  • Cholesterol, HDL / blood*
  • Clofibric Acid / therapeutic use
  • Combined Modality Therapy
  • Diet
  • Down-Regulation
  • Drug Therapy, Combination
  • Drugs, Investigational / therapeutic use
  • Dyslipidemias / blood
  • Dyslipidemias / complications
  • Dyslipidemias / therapy*
  • Exercise
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypolipidemic Agents / adverse effects
  • Hypolipidemic Agents / therapeutic use*
  • Niacin / therapeutic use
  • Peptides / therapeutic use
  • Receptors, Prostaglandin / antagonists & inhibitors
  • Risk Reduction Behavior*
  • Treatment Outcome
  • Weight Loss


  • Apolipoprotein A-I
  • CETP protein, human
  • Cholesterol Ester Transfer Proteins
  • Cholesterol, HDL
  • Drugs, Investigational
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents
  • Peptides
  • Receptors, Prostaglandin
  • prostanoid D receptor 1, human
  • Niacin
  • Clofibric Acid