Findings of an observational study revealed an inverse relationship between higher serum small high density lipoprotein particles (S-HDLP) and lower mortality or need for lung transplantation in individuals with idiopathic pulmonary fibrosis (IPF). Researchers also observed a negative correlation between S-HDLP and the Gender Age Physiology (GAP) Index.

Barochia et al analyzed the clinical data and serum lipid levels from a discovery cohort of 59 patients with IPF and 56 healthy controls. Data from a multicenter cohort consisting of 207 patients with IPF obtained from the Pulmonary Fibrosis Foundation registry validated the data from the discovery cohort.

These investigators studied the association between lipids and clinical outcomes including forced vital capacity, the 6-minute walk distance, the GAP index, the need for lung transplantation, and mortality.

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The researchers used nuclear magnetic resonance (NMR) spectroscopy to measure the serum concentrations of S-HDLP. The validation cohort data confirmed the negative correlations observed in the discovery cohort between higher concentrations of S-HDLP and the GAP index. Decreased mortality and decreased incidence of lung transplantation correlated with higher serum S-HDLP (P <.05) for up to 3 years from study entry in both the discovery and validation cohorts.

However, the authors did not mention any association between S-HLDP serum concentration levels and the 6-minute walk distance or forced vital capacity outcomes in the results.  

“These findings support the hypothesis that S-HDLP may modify mortality risk in patients with IPF,” the authors wrote.

Therefore, this study’s findings allow healthcare providers to deduce that encouragement of their patients with IPF to increase their HDL levels via lifestyle changes such as a healthy diet, regular exercise, and smoking cessation would be beneficial. If patients with IPF successfully adhere to these lifestyle choices, they may proactively improve their own prognoses by avoiding lung transplantation and decreasing risk of death related to their disease.


Barochia AV, Kaler M, Weir N, et al. Serum levels of small HDL particles are negatively correlated with death or lung transplantation in an observational study of idiopathic pulmonary fibrosis. Eur Respir J. 2021;2004053. doi:10.1183/13993003.04053-2020