Low HDL, but no other risk factors

I am a healthy 38 y.o. male, 6'2", 195 lbs, 34 inch waist, non-smoker and drug user. Recent BP was ~115/75, HR 73.  I exercise 3-5x/week (30 min aerobic exercise on cross-trainer), and drink alcohol in moderation (2-3 drinks/day, 3-5 days/week).

What brings me here in my low HDL. It always seems to be in the mid to upper 20's whether I am physically active or not. My most recent laboratory numbers from last week's blood work:

Trig 130 (20-160)
TC 145 (120-200)
LDL 94 (0-69)
HDL 25 (32-96)

Values seem to have shifted somewhat from last year, when I was on a strict low fat diet to lose weight (lost 30 lbs). From what I can remember, values last year at that time were TC 119, LDL 79, HDL 28.

As far as family history is concerned, the only relatives who had cardiovascular problems were life-long smokers. Both parents are still alive in their mid-60's with no cardiovascular history.

I am not sure whether or not I should be doing anything about my low HDL. My doctor (internal medicine) did not seem overly concerned. I asked him about Niaspan but he didn't think the risk/benefit profile really justified it given the side effects. However, he does not specialize in cardiovascular disease prevention so I thought I'd get a second opinion. I had been prescribed a fibrate once when I was hospitalized for an unrelated condition to manage this but it gave me diarrhea, so I don't think that is an option for me.

My questions are:

1. For someone like myself where low HDL appears to be the only risk factor, do you typically recommend drugs like Niaspan or lifestyle changes?

2. Are you aware of any research showing a clear benefit from Niaspan in people with low HDL (who are otherwise healthy) in terms of preventing future cardiovascular problems?

3. How common is it for someone with my profile to develop cardiovascular disease (am I at low or moderate risk)?

4. Would you recommend any tests at this time (e.g. calcium score)?

[Lee Kirksey, MD]

Hello
Thanks for the question. Its great to see younger people in the proactive preventative mode of thinking about their health. Having said that, I am a big fan of optimizing lifestyle issues before one proceeds down a line of medications. This includes exercise as you appear to be doing but it also includes an optimal health diet. Your alcohol consumption is detrimental to your body weight and ultimate health goals. As you know right now, you are consuming an extra 2000 calories per week just through alcohol.

Otherwise, your cardiac risk profile is elevated because of your strikingly low HDL. First line therapy is exercise and diet. Need for other treatment, like niaspan, would be dictated by the presence of other factors including elevated CRP,  increased homocysteine and increased insulin resistance


The presence of other risk factors and the lack of response to lifestyle changes would suggest a need for medical therapy.  I would also encourage you to visit my website www.optimalhealthtoday.com and click on left hand link about cardiac risk profile testing. It describes some of the newly available cutting edge tests that allow more detailed fractionation of your cholesterol as well as genetic tests for risk profile.

A calcium score would be very low yield at your age. You would benefit most from the risk stratification by biochemical measures that I described.

There is a recent article in New England Journal of Med that describes significantly elevated cardiac risk for patients with low HDL and other risk factors

Good Luck and Best of Health

Read more about the Optimal Health Lifestyle in Your Guide to Optimal Health at www.personalwellnesswheel.com