Paradoxical Hypercholesterolemia in an Otherwise Healthy Adult Man

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Hypercholesterolemia is characterized by serum cholesterol levels greater than 5 mmol per L. However, the distribution of cholesterol among lipoprotein classes has a significant bearing on diagnosis: high–low-density lipoprotein (LDL) cholesterol suggests familial hypercholesterolemia, whereas high–high-density lipoprotein (HDL) cholesterol is associated with hyperalphalipoproteinemia. On routine screening, a 23-year-old man presented with a total cholesterol level of 7.6 mmol per L but was subsequently found to have an HDL cholesterol level of 5.6 mmol per L. The clinical picture was confounded by his use of red yeast rice extract, a popular health supplement with hypolipidemic effects. In this case individual, the use of red yeast rice extract caused a hyperlipidemic state, ostensibly through downregulation of cholesteryl ester transfer protein. This case emphasizes the extended role of laboratory medicine in complex cases of hyperlipidemia.
Original languageEnglish
Pages (from-to)217-220
Number of pages4
JournalLaboratory Medicine
Issue number2
Early online date15 Aug 2019
Publication statusPublished (in print/issue) - 1 Mar 2020


  • cholesteryl ester transfer protein
  • clinical chemistry
  • red yeast rice extract
  • hyperalphalipoproteinemia
  • herbal medicines
  • omega-3 fatty acids


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