lipid values

My question concerns cholesterol values. My wife is 56 yo. She has high a cholesterol value, but very high HDL's. Specifically:
TC           285
Trigly       63
HDL        82
LDL         190
Chol/HDL 3.5
To complicate matters, she does have a 2nd risk fa, in that she has had elevated BP readings in the past,(during a period of stress) for which Lisinopril had brought it down to 110/70. In fact, we are weaning her from it currently. Thus, that's only "sort of" a risk factor. Of course, even with no risk fa's, I realize the LDL is high. However, do you know the latest thinking re:witholding Rx in pts with high LDL if the ratio is <4 and the HDL is very high? Or, where I can find this info.
Thanks for your time.
Larry Novik, MD

[erijon]

Even with her high HDL, her LDL is just too high. The AHA reccommends a level under 130, she is well above that. I would try lifestyle changes first, diet and exercise. That in combination of her high HDL may be enough. If it desn't come down then she may need a statin to get the LDL down to an acceptable level. Remember, LDL is the cholesterol that causes plaque and HDL is the cholesterol that binds with LDL to remove it from her blood. She NEEDS a high HDL to keep up with that LDL. I think the ratios go out the windows when a total and LDL cholesterol number gets that high.

Just my opinion from what I've read, hope it helps.

Good luck,

Jon

[LarryN]

Hi,
I appreciate your comment. I have always thought of HDL as something that prevents plaque formation in the artery, not just something that removes LDL from the circulation.
After your comments, I looked at an AHA (American Heart Assoc) link, which says:
Medical experts think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it's passed from the body. Some experts believe that HDL removes excess cholesterol from arterial plaque, slowing its buildup.
Thus, you are correct, and I MIGHT be correct.
Also, in the spirt of just talking about this subject, I am reasonably sure that the AMA rec's an LDL goal of 55 in a woman.) Of couse, if we determine that she really DOES have hypertension, then she would have a second risk factor, and the goal would then be <130.
Of course, it is possible that the AMA has different goals from the National Education Cholesterol Program (I think that's what they're called) but I didn't think so.
Thanks.
Larry