Normalization of triglycerides in type IV hyperlipoproteinemia fails to correct low levels of high-density-lipoprotein cholesterol.

High-density-lipoprotein (HDL) cholesterol protects against coronary heart disease, and ways to raise low HDL values are being sought. Cross-sectional population surveys have shown that HDL cholesterol is inversely related to plasma triglycerides, yet to our knowledge no longitudinal studies have shown that a decrease in elevated triglycerides will raise depressed HDL levels. We therefore used dietary therapy to lower the triglyceride levels of 29 men with Type IV hyperlipoproteinemia and evaluated the effects on HDL-cholesterol levels. Despite a reduction in triglyceride levels from 697 +/- 90 to 333 +/- 37 mg per deciliter (P < 0.01), initially low HDL-cholesterol values did not change (29 +/- 1 to 30 +/- 1 mg per deciliter). Even in a subgroup of 12 men whose triglyceride levels fell to normal (from 670 +/- 99 to 170 +/- 7, P < 0.01) and whose weight and triglycerides remained stable for two years, HDL cholesterol remained unchanged (29 +/- 1 vs. 32 +/- 1). The persistently low HDL-cholesterol level in the presence of normalization of triglycerides suggests that depressed HDL cholesterol may be an independent metabolic abnormality in Type IV hyperlipoproteinemia.