Ask a doctor on the topic of Internal medicine

Low HDL and A1c at 5.5 despite plenty of exercise is okay.

October 31, 2018 | 25,00 EUR | answered by Dr. med. Frauke Gehring

I have been getting a blood test done every year for at least 10 years (now 47) (original reason: thyroid after surgery). The values are always roughly the same (weight during this time between 85 and 97 kg at 173 cm):
- HbA1c between 5.2-5.6. (no trend)
- HDL always around 40 (I exercise 3-4 times a week, weight training and table tennis at the club)
- LDL between 150-180
- Cholesterol usually below 200
- Balanced diet, but lots of meat and 1-2 glasses of wine per day, rarely/never significantly more
I know I am overweight, but I also carry a lot of muscle, so a BMI of 32 doesn't bother me. Apart from a few knee problems (skier), no restrictions.
My question: 1.) the HbA1C is close to the pre-diabetic value of 5.7%, should I investigate this further or pay more attention to the values, 2.) HDL is always low despite sometimes even more exercise (marathon), should I possibly boost the HDL/LDL value with medication to reduce my risk or does that not make sense?

Dr. med. Frauke Gehring

Good day,

1.) Those are still very decent values. Your alcohol consumption is a bit high, one should not drink more than 1 glass of wine per day (on average). If you reduce that, the HbA1c value will improve even more, and that is sufficient. I do not see these values as pre-diabetes.

2.) If you are a man, that explains it, they often have relatively low HDL values (genetic risk). However, we know that medication treatment in otherwise healthy individuals does not extend life by a single day or prevent vascular disease. Therefore, it is not sensible to influence the value with medication. If you do not smoke and continue to be physically active, you are engaging in sufficient prevention.

It is enough to check the values every 2 years and the blood pressure annually, and I would try not to gain any more weight.

Warm regards, Dr. Gehring