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July 12, 1993

Low Levels of High-Density Lipoprotein Cholesterol (Hypoalphalipoproteinemia): An Approach to Management

Author Affiliations

From the Preventive Cardiology Center, Section of Cardiology, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill.

Arch Intern Med. 1993;153(13):1528-1538. doi:10.1001/archinte.1993.00410130030004

Clinical management of dyslipidemias has focused primarily on the low-density lipoprotein cholesterol (LDL-C) fraction; however, lipid disorders accompanied by low levels of high-density lipoprotein cholesterol (HDL-C) (hypoalphalipoproteinemia) are common, particularly among subjects with the diagnosis of coronary artery disease prior to age 55 years. The therapeutic objectives for high-risk subjects with dyslipidemias is directed initially toward reduction of the LDL-C fraction; thereafter, aggressive efforts aimed at raising the HDL-C fraction may be warranted. Strategies for raising the HDL-C fraction start with hygienic measures that include aerobic exercise, weight loss, smoking cessation, withdrawal of agents secondarily lowering HDL-C, and estrogen replacement. Pharmacotherapy selected according to the dyslipidemia that accompanies the HDL-C disorder is indicated for subjects who manifest premature coronary artery disease or who have a familial history of coronary artery disease and hypoalphalipoproteinemia.

(Arch Intern Med. 1993;153:1528-1538)