Would you prescribe a lipid-lowering agent to a 55-year-old man with a history of hypertension and an HDL of 75 mg/dL and LDL of 165 mg/dL? Is there an HDL level above which treatment is unnecessary?
—Henri H. Nammour, MD, Port Orange, Fla.

This patient has three risk factors for CAD: (1) middle-aged male, (2) hypertension, and (3) high LDL. On the other hand, his HDL is also high (which is good), he is not diabetic, and he apparently doesn’t smoke. You could treat this patient with diet only or start him on a low dose of a statin, e.g., atorvastatin (Lipitor) 5 mg. That dose is unlikely to have side effects and will lower the LDL without too much effect on the HDL. Current thinking is focused mainly on the LDL level (J Am Coll Cardiol. 2005;46:1411-1416); so as long as it is elevated, I prefer treatment, even in the presence of high HDL values. (But show me someone with an HDL >100, and I might change my mind.)
—Peter F. Cohn, MD (105-1)

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