The long-term clinical benefits of reducing elevated levels of low-density lipoprotein cholesterol (LDL-C) have been demonstrated. The reduction in coronary event rate in the statin trials was about 30-35%, so the majority of the patients whose LDL-C was lowered by treatment still had a cardiovascular event. To optimize the efficacy of LDL-lowering therapy different or additional therapeutic targets need to be considered. An appropriate approach is to increase high-density lipoprotein cholesterol (HDL-C) level in addition to decreasing high levels of LDL-C to reduce the risk of coronary heart disease (CHD). The association between low HDL-C and increased CHD morbidity and mortality has been demonstrated in many epidemiologic studies. The data of VA-HIT showed for the first time that raising low levels of HDL-C in patients with CHD and normal LDL-C reduces CHD event rate significantly. According to VA-HIT findings for every 1 mg/dl increase in HDL-C there was a 2-3% decrease in CHD death or MI. The data of the study suggest that elevation of low HDL-C may have an equally large impact on cardiovascular events as lowering LDL-C. Further therapy should be considered for patients who have reached target LDL-C levels and having low HDL-C or patients who have isolated low HDL-C. Life-style changes that include weight reduction, a diet low in carbohydrates moderate in unsaturated fat rather than low-fat, regular exercise, smoking cessation can effectively increase low levels of HDL-C and may reduce the need for drug therapy. Niacin, fibrates, and estrogens are pharmacological agents which increase low HDL levels effectively. In this review we focused on epidemiological and clinical studies suggesting the importance of HDL-C and overviewed the efficacy of lifestyle changes and available drugs for raising serum HDL-C levels.
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