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[Hyperalphalipoproteinemia: causes of therapeutic errors in primary care]
E Márquez Contreras1, F Rodríguez Peña
1Centro de Salud La Orden, Huelva.
Objective:
To consider using request for cholesterol together with high density lipoproteins (cHDL) before any hypolipemic treatment.
Design:
Three clinical observations.
Location:
General medicine surgery of the La Orden Health Centre in Huelva.
Patients:
Patients diagnosed with hyperalphalipoproteinemia in whom the total cholesterol (Ct) rate did not lower after treatment with hypolipemic drugs and diet.
Measurements And Results:
In all patients, the Ct, triglyceride (TG), cHDL, cholesterol together with low density lipoproteins (cLDL), very low density lipoproteins (cVLDL) and apoprotein A1 (Apo A1) were determined using enzymatic, ultracentrifuge and immunonephelometric methods. The cHDL reference value was 30-70 and 30-85 mg/dl in males and females respectively. The results obtained in the three observations were: Ct (288, 292 and 284 mg/dl) cHDL (118, 122 and 114 mg/dl) Apo A1 (2.44, 2.36 and 2.02 milligrams) which were all high, whereas cLDL and cVLDL and the TG obtained normal results.
Conclusions:
We consider it necessary to carry out a cHDL and cLDL study before starting any type of hypolipemic treatment. The clinical importance of correct diagnosis of hyperalphalipoproteinemia is obvious, as hypercholesterolemia can be treated with hypolipemic drugs in spite of cLDL being normal. The cases described underline the importance of basing decisions on the treatment of hypercholesterolemia in cLDL figures and not in Ct figures.