What should be the approach to low levels of HDL cholesterol?

Lowering the plasma level of low density lipoprotein (LDL) is a treatment which is recommended in guidelines for prevention of coronary artery disease. Decreased risk of coronary heart diseases is shown in the studies in which statins are used. Prospective epidemiological studies show that low level of high density lipoprotein (HDL) cholesterol is an independent and a major risk factor for development of acute coronary events. This effect occurs independently of LDL and triglyceride levels. The protective effects of HDL cholesterol on atherosclerotic lesions are explained by several mechanisms. Reverse cholesterol transport to liver has a major role here. Also, HDL cholesterol has antioxidant, anti-inflammatory and endothelial dysfunction regulatory effects. Lifestyle changes and pharmacotherapies are used to increase plasma levels of HDL cholesterol. New treatment strategies that increase levels of HDL cholesterol significantly reduces incidence of cardiovasculary events. Although the clinical consequences of increase levels of HDL cholesterol are good, how much and how to increase is still a controversial issue. We aimed to show the approach to the low levels of HDL cholesterol in this review.