血液中高密度脂蛋白膽固醇(HDL-C)偏低是臨床上常見並且具有挑戰性的一個問題。美國國家膽固醇治療小組指出，男性HDL-C < 40 mg/dL和女性HDL-C<50 mg/dL是偏低的。低HDL-C與早發性冠心病相關，隨著血脂篩檢建議增加之後被識別的頻率也越來越高。流行病學資料發現HDL-C每增加1 mg/dL，心血管事件就減少2~3%，影響大於低密度脂蛋白膽固醇(LDL-C)。然而，使用藥物治療以提高HDL-C並沒有被清楚地證明，可以減少不良的心血管預後。這個難題已經迫使醫生重新考慮現有的和新興的數據並針對HDL的生物學以制定治療策略來優化臨床結果。低HDL-C的次要原因應及時檢測，其中有一些是可逆的或人為的。史塔丁類藥物仍然是低HDL-C濃度併有顯著心血管疾病危險患者的第一線治療。治療性的生活方式的改變，可以提供一般健康的好處，包括改善HDL-C濃度和功能的可能性。具體的HDL-C標靶療法，纖維酸類藥物可能是具有顯著的心血管風險患者的合理使用藥物，如果三酸甘油酯明顯升高，例如 > 200 mg/dL，並且低HDL-C，則可伴隨著史塔丁類藥物使用。菸鹼酸的使用仍未經大型臨床試驗確證其臨床效益，但如果可容忍，理論上仍然是下列患者的另一個選擇，包括：(1)大幅度脂蛋白(a)升高的患者。(2)史塔丁類藥物不能容忍者。(3)已經使用史塔丁類藥物治療但是仍然有低HDL-C和漸進性心血管事件發生的患者。

A low level of circulating HDL-C represents a problem that is both common and clinically challenging. The National Cholesterol Treatment Panel recognizes the sex-specific cutoffs of HDL-C <40 mg/dL for men and <50 mg/dL for women as undesirable. Low HDL-C, linked to premature coronary artery disease, being identified with increasing frequency as lipid screening recommendations is increased. Epidemiological data indicate that a 1 mg/ dL increase in HDL-C would correlate to a 2% to 3% reduction in cardiovascular events, an impact greater than that noted for LDL-C. However, pharmacological interventions that raise HDL-C have not been clearly shown to reduce adverse cardiovascular outcomes. This conundrum has forced clinicians to reconsider existing and emerging data on HDL-C biology and therapeutic strategies to optimize clinical outcomes. Low HDL-C levels should prompt testing for secondary causes, some of which are reversible or artifactual. Statins remain the first-line therapy among individuals with low HDL-C levels and significant cardiovascular risk who warrant intervention, as defined by validated risk algorithms. Therapeutic lifestyle changes may offer general health benefits, including the possibility of improved HDL-C levels and functions. In terms of specific HDL-C-targeting therapies, fibrates may be reasonable to use in patients with significant cardiovascular risk, along with statins, if triglycerides are significantly elevated, eg, >200 mg/dL, and HDL-C is low. Niacin, still without a large clinical trial of its clinical effectiveness, but if tolerable, remains another theoretical option in patients with (1) substantially elevated lipoprotein(a), (2) statin intolerance, (3) in addition to statin therapy, in patients with isolated low HDL-C and progressive cardiovascular events. (J Intern Med Taiwan 2014; 25: 389-402)