Is a significantly elevated HDL (90-100 mg/dL) cause for concern?
—Kelly VanWagner, MD, Henderson, Nev.

In general, high levels of HDL are associated with decreased cardiovascular risk. However, the different constituents of HDL have qualitative effects on its function and metabolism, and the composition of HDL particle size relates to its antiatherosclerotic properties. The same HDL level has varying protectiveness, depending on its actual composition.

A genetic deficiency in cholesterol ester transfer protein (CETP) is associated with marked increases in HDL levels in homozygotes and with moderate increases in heterozygotes. A Danish study that evaluated the effect of this mutation on lipids and risk of ischemic heart disease (IHD) found that although this mutation was associated with elevated HDL, it was also associated with increased IHD in white women (Circulation. 2000;101:1907-1912).
—Norma M. Keller, MD (108-4)

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