DIFFERENTIAL RESPONSE OF HIGH-DENSITY-LIPOPROTEINS TO FIRST-STEP LIPID-LOWERING DIET ACCORDING TO THEIR INITIAL LEVEL

Background: A lipid-lowering diet has been shown to lower total cholesterol but also high-density-lipoprotein (HDL) cholesterol. The effect of the first-step lipid-lowering diet (as suggested by the European Atherosclerosis Society) on HDL levels was studied in 129 Greek patients aged 52.7 +/- 9.8 years, of whom 78 were men and 51 women of similar ages. Methods: Total, HDL, and low-density-lipoprotein (LDL) cholesterol, and the total:HDL cholesterol and triglyceride ratio were assessed before and 3 months after the diet. Results: Overall, total cholesterol decreased by 12% (P < 0.001), LDL by 15% (P < 0.001), HDL by 3% (NS), triglycerides by 12% (P < 0.01), and total : HDL cholesterol ratio by 11% (P < 0.001). A difference was found in the response to diet according to baseline HDL levels: in patients with HDL of 39 mg/dl or higher (group A), HDL decreased by 10% and the total:HDL cholesterol ratio by 3%, whereas in those with HDL lower than 39 mg/dl (group B) HDL increased by 17% and the total :HDL cholesterol ratio decreased by 22%. The difference between the groups was statistically significant (P < 0.001) for these two values as well as for triglycerides, but not for total cholesterol and LDL. No difference in the responses between men and women was found. Conclusion: This differential response to diet should be taken into account when planning treatment. Patients with baseline HDL levels higher than 39 mg/dl should probably be considered for early treatment not only by diet but by lipid-lowering-HDL-raising drugs as well.