What is the recommended treatment for a high density lipoprotein (HDL) level of 87?

Management of HDL Level of 87 mg/dL

No specific treatment is required for an HDL cholesterol level of 87 mg/dL, as this represents a favorable lipid profile that may actually be protective against cardiovascular disease. 1

Understanding High HDL Cholesterol

• An HDL cholesterol level of 87 mg/dL is considered well above the recommended target levels and falls into the "low risk" category for cardiovascular disease 1
• Current guidelines consider HDL levels ≥60 mg/dL as optimal and a "negative" risk factor that can actually subtract from overall cardiovascular risk assessment 1
• For context, guidelines recommend HDL levels >40 mg/dL for men and >50 mg/dL for women as desirable targets 1, 2

Clinical Significance of Elevated HDL

• High HDL levels are generally associated with reduced cardiovascular risk through several mechanisms:
  • HDL participates in reverse cholesterol transport, removing lipids from peripheral cells 3
  • Higher HDL levels are inversely associated with coronary heart disease events in epidemiological studies 3, 4
• An elevated HDL of 87 mg/dL should be viewed as a protective factor rather than a condition requiring treatment 1

Recommended Approach

Assessment of Overall Lipid Profile

• While the HDL level is high, it's important to evaluate the complete lipid profile including:
  • LDL cholesterol (primary target for therapy) 1
  • Triglycerides 1
  • Total cholesterol 1
• Calculate non-HDL cholesterol (total cholesterol minus HDL) to assess overall atherogenic risk 5

Focus on Other Cardiovascular Risk Factors

• Instead of treating the high HDL, focus on other modifiable cardiovascular risk factors:
  • Ensure LDL cholesterol is at appropriate target (<100 mg/dL for high-risk patients) 1
  • Maintain triglycerides <150 mg/dL 1
  • Address other risk factors such as hypertension, smoking, and diabetes 1

Maintain Healthy Lifestyle

• Continue or adopt lifestyle behaviors known to support healthy lipid profiles:
  • Regular physical activity 6
  • Healthy diet low in saturated fat (7-10% of calories) and sufficient in unsaturated fat (15-20% of calories) 6, 7
  • Weight management 6
  • Smoking cessation if applicable 6

Important Considerations

• Very high HDL levels (>100 mg/dL) have been associated with paradoxical increased risk in some studies, but an HDL of 87 mg/dL is generally not concerning 4
• Certain genetic variants can cause elevated HDL without necessarily conferring the same protective benefits 4
• The focus of lipid management should remain on LDL reduction as the primary target, with non-HDL cholesterol as a secondary target in patients with elevated triglycerides 1, 5

Follow-up Recommendations

• For patients with favorable lipid profiles (LDL <100 mg/dL, HDL >60 mg/dL, triglycerides <150 mg/dL), lipid assessments can be repeated every 2 years 1
• Continue to monitor overall cardiovascular risk factors rather than focusing on the elevated HDL 1