High-density lipoprotein cholesterol and treatment guidelines

Setting consistent guidelines for the treatment of lipid abnormalities must take into consideration several factors and must balance the need for precision (favored by specialists) and practicality in the patient setting (favored by general medical practitioners). The appropriate populations for treatment should be clearly defined, and usual threshold levels, target levels, and treatment should be well established. Plasma high-density lipoprotein cholesterol (HDL-C) has not been widely incorporated in guidelines as a significant abnormality predictive of cardiovascular risk and as a therapeutic target. However, that view is changing in the light of recent improved understanding of the importance of each lipid fraction abnormality, including HDL-C, in the pathophysiology of atherosclerotic disease. In addition, clinical trials have demonstrated the apparent benefit of increasing low levels of HDL-C in reducing cardiovascular events. The use of guidelines incorporating threshold and target levels for managing HDL-C in high-risk populations is becoming seen as a practical means of improving the outcome for patients, especially for special groups, such as the elderly and those with type 2 diabetes mellitus.