What pharmacologic interventions can increase total HDL and HDL2?
Several pharmacologic options may increase the total HDL and HDL2. The first option would be to change the agent used for glucose control, because different classes of drugs have variable effects on lipid parameters. You change WM from a sulfonylurea to a thiazolidinedione (rosiglitazone 4 mg/d). Thiazolidinediones have been shown to increase the total HDL-C by up to 20%.4,5 However, emerging evidence suggests that increases in the 30% to 35% range are possible when the total HDL-C is below 30. Therefore, a TZD at this point could raise the HDL to as high as 37 mg/dL. In addition, rosiglitazone has been shown to elevate the level of HDL2,6,7 which would confer additional benefits by decreasing the size of the LDL particles. Any rise in LDL-C levels is due to a shift from small dense to large buoyant LDL-C particles, which are less atherogenic. Other classes of drugs (eg, metformin, sulfonylureas) have negligible effects on HDL-C.
