Low HDL

Recommendations for people with low HDL levels are a little less cut-and-dried than those for the other lipid problems. That’s because we don’t have any studies showing specifically that if we raise HDL levels, heart disease risk goes down. We know HDL is good for the heart, so we believe that the higher the levels the better, but no studies have unequivocally proved that. Why? Because all the drugs we employ to raise HDL levels typically lower the LDL or triglyceride values at the same time. This makes it hard to tell which change caused the benefit of fewer heart problems. Recent animal studies have also shown that there may be good ways to raise an HDL cholesterol level and bad ways to do that, so without knowing how a drug has led to a change in HDL, one can’t readily predict if its effects would be beneficial or detrimental.
None of the statins alter HDL levels very dramatically (about 4 percent to 10 percent increase), whereas the fibrates and niacin do a better job of raising HDL levels (about 10 percent to 15 percent). Despite the unanswered questions about treating HDL, it is a very important blood value, with some studies indicating it predicts coronary disease risk better than any other single lipid value. The large observational study called the Framingham Heart Study suggests that every 1 mg/dL decrease in HDL increased the risk of having a heart attack by 2 percent to 3 percent. And the NCEP classifies an HDL level below 40 as a major risk factor for developing heart disease.
Most doctors don’t often prescribe medications to raise HDL levels, because the drug that works best—niacin—can be hard to take and may have side effects that are particularly undesirable in
the population most likely to have low HDL levels: diabetics. More options should become available in the near future, as the study of HDL metabolism is the most active area of cutting-edge research in the lipid field, and several new approaches are currently in early clinical trials. Luckily, though, there are a lot of lifestyle changes that raise HDL levels that are also beneficial to the rest of your cholesterol profile, your heart in general, and just about every other part of your body. The following can help you raise your HDL level:
• Exercising
• Not smoking
• Avoiding foods with trans fats (a lot of margarines, fried foods, some commercial baked goods)
• Losing weight if you’re overweight
• Drinking a small amount of alcohol every day (typically one drink for women, two for men)
Again, while we don’t know if raising HDL through these changes will help prevent heart disease, we do know that their other benefits will definitely decrease heart disease risk.