Should You Try to Raise Your HDL?
For many years, the formula for better heart health has included measures to reduce the levels of low-density lipoprotein (LDL) cholesterol while at the same time increasing the levels of high-density lipoprotein (HDL) cholesterol in their circulating blood.
And while a high level of LDL—the so-called “bad” cholesterol—continues to be recognized as a major contributor to cardiovascular disease, investigators at UCLA and elsewhere suggest that taking measures to elevate blood levels of HDL—“good” cholesterol—may be of little, if any, therapeutic value.
“Although we know that a low HDL level puts a person at elevated risk for heart attack and stroke, clinical trials have been unable, at least so far, to demonstrate a reduction in clinical events as a result of raising HDL,” says Gregg Fonarow, MD, professor of cardiovascular medicine at Ronald Reagan-UCLA Medical Center and co-director of the university’s Preventative Cardiology Program. “This doesn’t mean that researchers won’t, at some point in the future, find a method of raising HDL in a way that leads to an increase in risk reduction. But as of now, this has not been accomplished.”
A significant role
A low HDL blood level may or may not directly increase a person’s risk for heart attack and stroke. Indeed, Dr. Fonarow and other experts believe that this lipoprotein—even at a low blood level—can play a significant role in maintaining good cardiac health. Most important in this regard is HDL’s ability to remove plaque (waxy accumulations of LDL) from the linings of artery walls, and to transport it to the liver, where it is recycled, turned into bile acids, and subsequently used for digestion. Without HDL’s influence, it would seem, the accumulated LDL particles would almost inevitably clog the arteries and could eventually cause heart attack or stroke.
Patients who seek to raise their HDL blood levels are encouraged to follow general heart-healthy steps, such as aerobic exercise most days of the week; quitting smoking; maintaining a healthy weight; and eating a diet that avoids trans fats and refined carbohydrates, such as white-flour products.
What about niacin?
A healthy lifestyle may not be enough to get you to your HDL target, however. The B vitamin niacin has been shown to raise HDL. However, Dr. Fonarow points out that, “no study has yet convincingly demonstrated that raising HDL actually lowers the risk of heart attack or stroke. In fact, some studies of newer medications—in which HDL was raised 30 to 40 percent—showed absolutely no reduction in clinical events among study subjects. So raising HDL levels, at least as with currently available therapies, is not something that can be translated to clinical benefit.”
Niacin is available as an over-the-counter supplement, either by itself or as part of a multivitamin. Higher doses of niacin may be prescribed by your doctor. But before starting niacin therapy, you should discuss the matter with your doctor.
Focus on lowering LDL
Rather than raising HDL blood levels, says Dr. Fonarow, reducing the risk of heart attack and stroke must instead involve the lowering of LDL levels, which he says is “absolutely critical. This is true for people who are of healthy weight, somewhat overweight, or obese,” he points out. “And it’s true for those who exercise regularly and for those who are sedentary, for both men and women, and for younger as well as older people. The classic recommendation for LDL is a level of less than 100 mg/dL or less than 70 mg/dL, depending on risk. This is one of the factors that we use in cardiovascular risk assessment, although there are individuals who, based on their overall risks, would still benefit from treatment.”
These numbers, however, are not absolute, he adds. “If you’re at intermediate risk, you’d want to get a 35 percent to 40 percent reduction in your LDL. If you’re a high-risk individual, you’d want a reduction of 50 percent or more,” Dr. Fonarow explains. Risk factors that must be considered along with the LDL level, he says, include a patient’s blood pressure, gender, and whether he or she is a smoker and/or is diabetic.
Dr. Fonarow urges men and women to have their cardiovascular risk assessed by a qualified physician at least once every five years. If found to be at elevated risk, you should seek follow-up tests every three or four months thereafter. “You should know your cardiovascular risk, and you should lower that risk by modifying your lifestyle accordingly,” he says. In many cases, he points out, a doctor will prescribe an LDL–lowering statin. Dr. Fonarow adds that, “the benefits that statins offer greatly outweigh any risks.”
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