Spotlight Series: Mixed Dyslipidemia


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Recognition and Treatment of HDL-C in Mixed Dyslipidemia


Summary


A low level of HDL cholesterol is common in patients with obesity, insulin resistance and mixed dyslipidemia, and is an important independent risk factor for coronary heart disease. Whether low HDL-C is causally related to CHD remains a topic of debate, but clinical intervention to raise HDL-C levels is of substantial interest. Lifestyle intervention, particularly exercise and weight loss, can help to raise HDL-C levels but is often limited. Nicotinic acid (niacin) is the best HDL-raising pharmacologic therapy currently available; while some outcome data suggest benefit, more data are needed and studies are ongoing. CETP inhibitors raise HDL-C substantially in humans, and despite the failure of torcetrapib, some CETP inhibitors are still in clinical development and have promise. Additional HDL-targeted therapies are also in development. The management of the patient with low HDL-C remains a challenge, and several cases are presented which illustrate the various challenges.


Learning Objectives


Upon completion of this session, the participants will be able to:


  • Explain the relationship of HDL-C levels and the risk of coronary heart disease.
  • List other cardiometabolic risk factors that accompany low HDL-C.
  • State lifestyle modifications and pharmacologic therapy that can raise HDL-C levels.
  • Describe the mechanisms of action and the pros and cons of therapies that raise HDL-C.
  • Summarize clinical trial data that evaluate therapies that raise HDL-C.

This topic is CME/CE certified by the American Heart Association for physicians, physician's assistants, nurses and pharmacists.