Sudden large drop in HDL

I am a 73-year-old female, generally in very good health with low risk factors for stroke or heart disease.  Past hypertension and hyperlipidemia have been well-controlled with medication for more than ten years.  In April 2011 my total cholesterol was 147; LDL 84; TG 85; HDL 46.

Last week I suffered a cryptogenic stroke of the left temporal cortex that presented with garbled speech and difficulty drinking from a cup. (Both symptoms have since resolved completely.)  At hospital admission I was also  extremely dehydrated and and my potassium was very low following several days of severe diarrhea.  (I have no history of chronic hypokalemia.)  Currently the only change from pre-stroke is a decrease in heart rate from a normal range of 60 to 70  to 42 to 55.

My primary concern is a sharp drop in HDL since April...down from 46 to 25 mg/DL.  I had believed that HDL values were mostly genetically determined and generally stable over a relatively narrow range.  

What could have caused such a large drop?  Other than the stroke there have been no changes in my health or lifestyle.  I do take a beta blocker, but the literature suggests that its effect on HDL is quite small.  I have been taking 50mg a day for hypertension for at least ten years with no problems, either with bradycardia or HDL values.  

Could the decrease in high density lipoprotein have caused my stroke?  How predictive might the low value be for a recurrence?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

HDL can be affected by weight, diet, exercise, smoking, aging process (hormonal effects), etc. I do not know why the drop in your HDL based on the information you provided. Many medications used for treating high cholesterol can increase the HDL. I would suggest you follow up with your PCP and discuss. You should also look at the LDL for stroke prevention.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Pia38]

Thank you for your response.  It is pretty much what I have heard from my stroke team and my PCP and what I have learned online...weight, age, diet, beta blockers, etc.  The problem remains that, according to my research, each of these affects HDL by only a few points...five to ten percent, not 54%...and except for the fact that I am six months older, none of the above factors has changed.  The good news is that my HDL appears to be increasing on its own.  Eleven days after my stroke it was back up to 35.  It still has a way to go, but perhaps the decrease is not permanent.  Sequestration, maybe?

Again, my thanks for your response.