Primary care physician treatment of low HDL: Rational approach or Pandora's Box?

Guidelines for treating high low-density lipoproteins are clear, whereas guidelines for treating low high-density lipoproteins (HDL) are less so. Physicians approach to treating low HDL cholesterol is not known.

To determine primary care physicians approach to managing low HDL.

Three-thousand, nine-hundred and nineteen surveys were mailed to all primary care physicians in the State of Indiana, asking questions regarding demographics, case studies to assess the provider's approach to managing low HDL, and direct questions regarding management of HDL levels and general lipid knowledge questions.

Seven-hundred and eighty-one surveys were returned, for a response rate of 19.9%. Fifty-eight percent of participants would initiate HDL-raising therapy after achieving the appropriate low-density lipoprotein cholesterol goal. The approaches used to raise HDL included lifestyle changes (diet, exercise, smoking cessation) (85%), niacin (83%), fibric acid derivative (61%), and alcohol (31%). Reasons inhibiting initiating therapy for raising HDL included concern over side effects (56%), perceived lack of effectiveness of currently available drugs (24%), lack of clear guidelines (22%), and lack of evidenced-based trials demonstrating benefit of raising HDL (14%). For men, 40% of physicians use 40 mg/dL as a cutoff for initiating HDL-raising therapy, while 25% using a cutoff of 35 mg/dL. For women, 24% use a cutoff of 50 mg/dL for initiating HDL-raising therapy, while 12% use 45 mg/dL as a cutoff.

The majority of primary care physicians in the State of Indiana treated low HDL with appropriate approaches, although use of alcohol to raise HDL raises concerns.