Risks Associated with Low HDL Cholesterol

Primary Cardiovascular Risks

Low HDL cholesterol is inversely correlated with coronary heart disease risk, meaning the lower the HDL, the higher the risk of developing CAD, as established by the American Heart Association 1, 4
The Framingham Study, supported by the National Heart, Lung, and Blood Institute, established that low HDL cholesterol levels correlate with higher risk of CAD in adults, providing foundational epidemiological evidence 1, 4
Individuals with familial isolated decreases in HDL cholesterol face increased risk of premature coronary artery disease, demonstrating a genetic component to this risk, according to the American College of Cardiology 1, 4

HDL cholesterol levels below 40 mg/dL in men and below 45-50 mg/dL in women indicate increased cardiovascular risk, though there is insufficient evidence to use HDL as a specific therapeutic target, as stated by the National Cholesterol Education Program 2, 5, 3
The major nongenetic determinants of low HDL include hyperglycemia, diabetes, hypertriglyceridemia, very low-fat diets, and excess body weight, according to the American Diabetes Association 2

Increased adiposity and sedentary lifestyle are believed to increase coronary disease risk in part through their association with reduced HDL cholesterol levels, as reported by the American Heart Association 6, 7
Smoking and obesity are strongly associated with low HDL cholesterol levels, according to the Centers for Disease Control and Prevention 1, 4
A moderate inverse relationship exists between triglyceride and HDL cholesterol concentrations, meaning elevated triglycerides typically accompany low HDL, as established by the National Lipid Association 2

Efforts to reduce adiposity and increase physical activity are of particular importance in individuals with HDL cholesterol levels lower than desirable, even though HDL itself is not an established treatment target, as recommended by the American College of Sports Medicine 6, 7
Statin therapy remains the cornerstone of management for patients with low HDL and elevated LDL, with every 30 mg/dL reduction in LDL producing proportional cardiovascular risk reduction, according to the American College of Cardiology 3