Patients with low levels of high-density lipoprotein cholesterol: to treat or not to treat?

S Tavintharan, SC Lim, CF Sum
Correspondence: Dr S Tavintharan, tavintharan_subramaniam@alexhosp.com.sg

ABSTRACT
Clinical evidence indicates that a low level of high-density lipoprotein cholesterol (HDL-C) is a major risk of atherosclerosis. Raising HDL-C reduces this risk significantly, making HDL-C levels an important target of treatment for dyslipidaemia, especially in pre-existent atherosclerosis. HDL-C is protective against atherosclerosis, largely due to its function of reverse cholesterol transport. Additionally, some important roles include fibrinolysis, antioxidant functions, and reduction of platelet aggregability. A number of agents potentially modify HDL favourably. Niacin is the most potent HDL-C raising agent currently available in clinical practice, followed by fibrates. CETP inhibitors show greater HDL-C rising, but are still used in trial settings only. HDL mimetic agents are another group of agents that offer much promise. Clinical outcome data are awaited for these newer therapeutic agents.

Keywords: apolipoprotein A-l, atherosclerosis, high-density lipoprotein, hypoalphalipoproteinaemia
Singapore Med J 2005; 46(10): 519-528