![]() Phenytoin increases high-density lipoprotein (HDL) cholesterol, and may also increase total cholesterol and serum triglyceride concentrations. In Meyler's Side Effects of Drugs (Sixteenth Edition), 2016 Serum lipids Future studies should clarify the possible benefits of this approach in autoimmune patients. Cholesteryl ester transfer protein (CETP) inhibitors have been shown to increase HDL-C and apolipoprotein A-I levels as monotherapy and combined with statins ( Nicholls et al., 2015), but strong differences exist between the effects of the various molecules, revised by Kingwell ( Kingwell et al., 2014). Moreover, studies with these agents in most cases are performed in addition to statin treatment, with a masking effect as a possible consequence. However, later reports showed more uncertain results ( Remaley et al., 2014 Gomaraschi et al., 2015) these agents also lower proatherogenic serum lipoproteins, rendering conclusive information on the specific clinical impact of HDL-C raising effect difficult to obtain ( Kingwell et al., 2014). Fibrates and niacin have been demonstrated to increase HDL-C together with decreasing CV risk ( Birjmohun et al., 2005). HDL-C increasing drugs have been object of great interest in the attempt to lower the so-called residual CV risk, still present despite optimal LDL-C control. Meroni, in Handbook of Systemic Autoimmune Diseases, 2017 3.4 High-Density Lipoprotein Cholesterol Increasing Drugs 19 However, as noted above, raising HDL-C has not been proven to be a valid therapeutic approach to improve ASCVD outcomes. 8 Nicotinic acid is the most potent clinically available pharmacotherapy that raises HDL-C levels, with differential and weaker effects seen after administration of fibrates and statins (see Table 8.1). 3,7 Lifestyle interventions that are associated with increases in HDL-C include smoking cessation, weight loss, reduced carbohydrate consumption, increased physical activity, and moderate alcohol consumption. 10 HDL-C levels below 40 mg/dL (1 mmol/L) in men and below 50 mg/dL (1.3 mmol/L) in women are considered major ASCVD risk markers however there is insufficient evidence to support raising HDL-C as a treatment target. Low HDL-C is one of the five components of the metabolic syndrome and is often part of a lipid triad that includes high triglycerides and small dense LDL particles. Low HDL-C levels are associated with smoking, insulin resistance, hypertriglyceridemia, and physical inactivity. 9 HDL-C levels have a significant inherited component and are typically higher in women and in those of African descent. Observational studies show consistent relationships between low HDL-C (< 40 mg/dL) (1 mmol/L) and increased ASCVD risk ( Fig. HDL-C is the other major lipid used in validated risk scoring algorithms. Anand Rohatgi, in Chronic Coronary Artery Disease, 2018 High-Density Lipoprotein Cholesterol
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