High HDL Cholesterol Level

Question

A 68 year old women with a BMI of 28.5 and antihypertensive treatment, has a total cholesterol level of 300mg/dl, an LDL cholesterol level of 150 mg / dl and an HDL cholesterol level of 100 mg / dl. Is the high HDL cholesterol level a cardiovascular protective factor that reduces the cardiovascular risk so that a drug lowering LDL cholesterol is unnecessary?

Answer

Even if a high HDL cholesterol level is shown to be a cardiovascular protective factor in epidemiologic studies, is not clear whether or not this mitigates the effect of a simultaneous increase in atherogenic LDL cholesterol. Since there are no adequate study data, there are no clear recommendations on how to proceed if a patient has both increased the LDL- and the HDL-cholesterol. The only so- lution to this dilemma is to calculate the total cardiovascular risk – in which as a rule the HDL value does not enter – and then to make a treatment decision. If this falls short for „treating“, a high HDL can possibly be an argument against the treatment.

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(State: 16.11.2012)