What is the current recommendation for treating isolated low HDL levels? My patient is a 37-year-old white nonsmoker, whose original total cholesterol was 168 mg/dL, triglycerides 144 mg/dL, LDL 102 mg/dL, and HDL 37 mg/dL. After six months of dieting and intense aerobic exercise, his total cholesterol fell to 109, triglycerides 49, LDL 67, and HDL 32. This makes his non-HDL cholesterol 77 and his cholesterol ratio 3.4. At what point should I start pharmacologic treatment for low HDL?

While your patient does indeed sound ideal in most ways for managing his lipids, the National Cholesterol Education Program Adult Treatment Panel III recently redefined the HDL level that constitutes a formal coronary heart disease risk factor as <40 for both men and women. Not knowing his other risk factors (i.e., family history, etc.), I would consider such treatments as fish-oil capsules. Also, HDL changes tend to be long term, so continued monitoring for another 6-12 months is advised.
—Sherril Sego, MSN, FNP (118-13)