Lipoprotein Checklist: Low HDL
High-density lipoprotein particles, or HDL, transports cholesterol away from artery walls and delivers it to the liver for disposal (a process called “reverse cholesterol transport”). The most important, hard working fraction of the HDL family is large HDL, sometimes called “HDL 2b,” the most effective fraction of HDL for removing cholesterol. Large HDL is commonly deficient when total HDL is less than or equal to 60 mg/dl.
The lower the HDL, the greater the risk for coronary plaque; the higher the level, the lower the risk. The same holds true for large HDL. Low HDL, along with small LDL, is the number one cause for heart disease and heart attack in the U.S. This pattern has assumed increasing importance as a cause for heart disease with the emergence of the metabolic syndrome as an enormous societal health problem. When occurring as part of this syndrome, low HDL is accompanied by increased triglycerides (>100 mg/dl), high blood pressure, increased inflammation (C-reactive protein), and excess abdominal fat.
Low HDL can also occur as a genetic disorder unaccompanied by the metabolic syndrome. In this case, HDL can be quite low, usually ≤30 mg/dl. This confers high risk for heart disease. Conversely—and contrary to popular opinion—a high HDL does not guarantee safety from heart disease. Risk for heart disease is indeed lower when HDL is >60 mg/dl, but it still commonly occurs.
The strategies to raise HDL are, unfortunately,
not as straightforward as those for reducing LDL. Most people who begin
with HDL of <40 mg/dl generally require several strategies to raise HDL.
The Track Your Plaque target for HDL is 60 mg/dl, the level at which it
ceases to be a factor in plaque growth. Treatments that increase total
HDL also tend to shift HDL towards the large fraction, as well.
How to Increase Low HDL
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