A 55 year old male with a history of hypertension has the following fasting lipid profile:
Total cholesterol 240 mg/dL
LDL cholesterol 98 mg/dL
HDL cholesterol 35 mg/dL
Triglycerides 140 mg/dL
Which of the following is the most appropriate treatment?
A. Diet and lifestyle modifications
B. Start niacin
C. Start gemfibrozil
D. Start an HMG-CoA reductase inhibitor
E. No therapy is needed
For men the goal HDL is > 40 mg/DL, thus diet and lifestyle modifications should be tried for 6 months prior to initiating niacin, which is the preferred drug used to raise HDL levels. Despite raising HDL levels, niacin lacks data to support a mortality benefit. His LDL level is normal according to ATP III guidelines. Other itnerventions that raise HDL levels include exercise (part of diet/lifestyle modifications), alcohol, omega-3 fatty acids, HMC-CoA reductase inhibitors (although only small effect), and estrogen.