From the Research
Further evaluation for a patient with elevated HDL cholesterol typically involves confirming the finding with repeat testing and assessing for secondary causes, as elevated HDL (>60 mg/dL) is generally considered cardioprotective, but extremely high levels (>100 mg/dL) may warrant genetic testing for conditions like CETP deficiency or hyperalphalipoproteinemia 1.
Initial Steps
Initial steps include obtaining a complete lipid panel to evaluate other lipid parameters (LDL, triglycerides, total cholesterol) and reviewing the patient's medical history, medications, lifestyle factors, and family history. Certain medications like estrogen, statins, fibrates, and niacin can raise HDL levels. Alcohol consumption, regular exercise, and genetic factors may also contribute to elevated HDL 2.
Laboratory Tests
Laboratory tests to consider include liver function tests, thyroid function tests, and blood glucose levels to rule out conditions like hypothyroidism or diabetes that can affect lipid metabolism. While the relationship between HDL and cardiovascular disease is complex, with some studies suggesting that extremely high HDL levels may paradoxically increase cardiovascular risk, the current evidence does not support specific treatment for isolated high HDL 3.
Management
No specific treatment is typically needed for isolated high HDL, but addressing any underlying causes and optimizing overall cardiovascular risk management remains important. This may involve lifestyle modifications, such as diet and exercise, as well as management of other cardiovascular risk factors, such as hypertension and diabetes 4.
Genetic Testing
In rare cases, very high HDL may warrant genetic testing for conditions like CETP deficiency or hyperalphalipoproteinemia, as these conditions can have significant implications for cardiovascular risk management 1.