{"id":"5f7b7d558ec8","type":"article","url":"https://hartvaat.nl/2026/12/01/extreem-laag-hdl-cholesterol-duidt-op-onderliggende-systemische-ziekte/","title":"Extreem laag HDL-cholesterol duidt op onderliggende systemische ziekte","title_en":"Prevalence, clinical characteristics, and etiologic spectrum of extremely low levels of high-density lipoprotein cholesterol in Thai patients: a single-center study.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Annals of medicine","doi":"10.1080/07853890.2026.2758510","source_url":"https://doi.org/10.1080/07853890.2026.2758510","authors":["Watcharapon Kiattikittikul","Kitti Thammakosol","Chutintorn Sriphrapradang"],"significance":4,"published":"2026-11-11","source_date":"2026-12-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/dyslipidemie-overzicht/"],"congress":"","summary_en":"A retrospective cohort study of over 217,000 patients found that persistently extremely low HDL cholesterol (<20 mg/dL) is exceedingly rare (0.008%) and predominantly driven by secondary systemic conditions such as liver disease and active malignancy. Patients with this phenotype faced a significantly higher risk of all-cause mortality (HR 4.33) compared to those with moderately low HDL, while atherosclerotic cardiovascular disease rates remained similar. Clinically, this underscores that extremely low HDL should be interpreted primarily as a marker of severe underlying illness rather than a direct driver of cardiovascular risk.","created":"2026-11-05T01:48:31Z","updated":"2026-11-05T01:48:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een retrospectieve cohortstudie onder meer dan 217.000 patiënten toont aan dat aanhoudend extreem laag HDL-cholesterol (<20 mg/dL) uiterst zeldzaam is (0,008%) en vooral voorkomt bij secundaire aandoeningen zoals leverziekte en maligniteiten. Patiënten met dit profiel hadden een significant hoger risico op overlijden (HR 4,33) vergeleken met patiënten met licht lager HDL, terwijl het aantal atherosclerotische cardiovasculaire gebeurtenissen niet verschilde. Voor de klinische praktijk betekent dit dat extreem laag HDL-cholesterol primair een waarschuwingssignaal moet zijn voor onderliggende systemische ziekte in plaats van een primaire lipidendrift.","abstract_original":"BACKGROUND: Extremely low high-density lipoprotein cholesterol (HDL-C) is uncommon and may result from secondary conditions or rare genetic disorders. Data on persistently low HDL-C in Southeast Asians remain limited. We aim to determine the prevalence, clinical characteristics, underlying etiologies, and clinical outcomes of patients with persistent low HDL-C. METHODS: This retrospective cohort study evaluated adults with persistently low HDL-C (<30 mg/dL) identified via laboratory and electronic medical records between January 2020 and December 2024. Patients were stratified into two phenotypes based on baseline HDL-C severity: markedly low (20-29 mg/dL) or extremely low (<20 mg/dL). RESULTS: Among 217,481 individuals undergoing lipid testing (1,053,662 HDL-C measurements), 164 patients had persistently low HDL-C (mean age, 56.9 years; 68.9% male). The prevalence of persistently low and extremely low HDL-C was 0.08% and 0.008%, respectively. Concomitant hypertriglyceridemia affected ∼75% of patients. Most cases were associated with secondary conditions. Extremely low HDL-C was more frequently associated with liver disease (41.2%) and active malignancy (29.4%), whereas metabolic syndrome predominated among patients with markedly low HDL-C (42.2%). During a median follow-up of 2.57 years, all-cause mortality was higher in the extremely low HDL-C group (29.4% vs. 11.6%; hazard ratio, 4.33; 95% CI, 1.58-11.91; p = 0.004), while atherosclerotic cardiovascular disease rates were similar between groups (35.3% vs. 32.0%). CONCLUSIONS: Persistently low HDL-C is an exceedingly rare phenotype driven primarily by secondary systemic conditions. An extremely low HDL-C level appears to be a marker of severe underlying systemic illness and was associated with higher short-term mortality."}