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Cardiovascular risk assessment
High-density lipoprotein (HDL) is the smallest of the lipoprotein particles and comprises a complex family of lipoprotein particles that exist in a constant state of dynamic flux as the particles interact with other HDL particles and with low-density lipoprotein (LDL) particles and very-low-density lipoprotein (VLDL) particles. HDL has the largest proportion of protein relative to lipid compared to other lipoproteins (>50% protein).
Total cholesterol levels have long been known to be related to coronary heart disease (CHD). HDL cholesterol is also an important tool used to assess an individual's risk of developing CHD since a strong negative relationship between HDL cholesterol concentration and the incidence of CHD has been reported.
In some individuals, exercise increases the HDL cholesterol level; those with more physical activity have higher HDL cholesterol values.
The National Lipid Association and the National Cholesterol Education Program (NCEP) have set the following guidelines for lipids (total cholesterol, triglycerides, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and non-HDL cholesterol) in adults ages 18 and up:
> or =40 mg/dL
> or =50 mg/dL
The Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents has set the following guidelines for lipids (total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, and non-HDL cholesterol) in children ages 2-17:
Low HDL: <40 mg/dL
Borderline low: 40-45 mg/dL
Acceptable: >45 mg/dL
Low high-density lipoprotein (HDL) cholesterol correlates with increased risk for coronary heart disease (CHD). Values > or =80 to 100 mg/dL may indicate metabolic response to certain medications such as hormone replacement therapy, chronic liver disease, or some form of chronic intoxication, such as with alcohol, heavy metals, or industrial chemicals including pesticides.
HDL values < or =5 mg/dL occur in Tangier disease, in association with cholestatic liver disease, and in association with diminished hepatocyte function.
Fasting is not necessary but is preferable. However, if the high-density lipoprotein (HDL) cholesterol data is used to calculate the low-density lipoprotein (LDL) cholesterol, fasting is required since triglycerides concentration is used in the calculation.
Result can be falsely decreased in patients with elevated levels of N-acetyl-p-benzoquinone imine (NAPQI, a metabolite of acetaminophen), N-acetylcysteine (NAC), and Metamizole.
1. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Edited by CA Burtis, ER Ashwood, DE Bruns. St. Louis, MO: Elsevier Saunders, 2012
2. Rifai N, Warnick GR: Laboratory Measurement of Lipids, Lipoproteins, and Apolipoproteins. AACC Press, Washington DC, 1994
3. Jacobson TA, Ito MK, Maki KC, et al: National Lipid Association recommendations for patient-centered management of dyslipidemia: Part 1 - executive summary. J Clin Lipidol 2014 Sep-Oct;8(5):473-488
4. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics 2011 Dec;128 Suppl 5:S213-S256