My Isolated Very Low HDL - Should I Be Worried? Should I Treat It?

[jbt1125]

Background: Although I do not remember the specific numbers, I know that I have always had somewhat low HDL. My mother says that both her and my grandmother do too. However, we have no early heart disease (or really, any heart disease that I know of) on either side of my family.  Since I am fairly young and healthy, I havent worried too much about this in the past. However, on a whim, I decided to take advantage of a freee cholesterol screening at a local clinic in my community. I havent had it tested in a long time, so I decided - why not?

Here are my numbers (fasted for 10+ hours except for a cup of black coffee morning of) -

Total: 101
HDL: 21
TRI:  Less than 50
LDL: Unable to calculate

I guess that because everything was so low, the machine couldnt calculate LDL. However, no matter how you slice it, it has to be extremely low with the other numbers.  

I am 38 yr old male, no significant family history of CAD, my blood pressure is usually below 120 systolic and below 80 diastolic.  I dont smoke. I dont drink any alcohol. I exercise occasionally, but not regularly.  My BMI is about 24. 12 months ago I had a negative stress echo. This test was order because of some atypical chest pain I was having. Diagnosis ended up being GERD and I now take 40 mg of Nexium daily. Over the last 12 months, I have also aggressively changed to a south-beach /low carb oriented diet. I lost approximately 30 lbs.

My questions:

1) given my low risk factors in general, should the low HDL worry me? I intend to make some lifestyle modifications to get it up - exercise more, fish oil, daily glass of red wine. But should I be running to my doctor, ER, etc.? I just dont know how to interpret such a strikingly low HDL amount. It has me panicked.
2) Obviously related to the first point, should this be treated. I.E. Niacin, etc.?

Thanks for your opinion.

[Lee Kirksey, MD]

Hello
Specifically, your low HDL is concerning. Low HDL correlates with a higher cardiac risk profile and you should focus on increasing healthy fats in your diet, have a repeat panel and consider further micro fractionation of your Lipid profile. see www.optimalhealthtoday.com. click on heart risk profile left margin.

[jbt1125]

Thank you Dr. Kirksey. I will definitely purchase the book. However, can you comment specifically on the HDL? I try to eat very healthy, have recently lost over 30lbs, etc...so I will repeat the lipid panel, but wouldnt be surprised if these are the results. The low triglycerides and low LDL, low total cholesterol is probably a great thing, right? Its the very low HDL that has me worried about risk for a heart attack.  thank you!

[Lee Kirksey, MD]

Hello
I would have your cholesterol panel repeated to confirm those levels. Fasting without coffee. As you know, fat is helpful for brain health in children and hormone production in adults. If these values are confirmed, you should consider supplementing naturally your fat intake with omega 3, 9 fish oils, avocado, nut butter, almond etc. My partner and I Dr Seema Patel have a chapter dedicated to this in Your Guide to Optimal Health: Creating Your Personal Wellness Wheel (amazon.com, personalwellnesswheel.com).
We also emphasize the important role of mindful meditation in all of these issues