The metabolic syndrome: a practical guide to origins and treatment: Part II.

Low HDL Cholesterol and Elevated Triglycerides Background It is appropriate to consider jointly the effects of low HDL cholesterol (HDL-C) and high triglyceride levels as components of the metabolic syndrome (MetS). In observational studies, each of these factors is related to greater risk of coronary heart disease,1,2 and clinical trials have been undertaken to prevent outcomes.3 Persons with high triglycerides often have low HDL-C levels and small, dense LDL particles. Estrogen therapy and excessive alcohol intake may disrupt this pattern, as each may cause simultaneous increases in HDL and triglyceride levels. A variety of environmental and genetic factors have been related to HDL-C and triglyceride levels in certain populations. For instance, lower HDL-C levels are found in cigarette smokers, obese persons, inactive individuals, and those who use androgens or 17 nor-derivatives of progesterone.4,5 Genetic variants of lipoprotein lipase, hepatic lipase, cholesterol ester transfer protein, and peroxisome proliferator-activated receptors (PPAR)have been shown to have effects on HDL-C and triglyceride levels in populations,6–10 contributing to the development of the MetS.