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Doctors aren’t the only ones telling people to lower their cholesterol. Television commercials also tout cereals from Quaker to Kellogg’s and medications that encourage viewers to become heart healthy and promise to lower LDL, the “bad” cholesterol.
But there is another type of cholesterol that physicians agree is important to raise â€” HDL, or the “good” cholesterol.
HDL works in opposition to LDL. Instead of increasing the risk of heart disease, it can help prevent heart attacks and stroke.
Doctors have known this for more than a decade, but cardiologists have recently started paying more attention to HDL after a study showed that giving doses of it could reverse plaque buildup in arteries, said Dr. Robert Rosenson, a preventive cardiologist at Northwestern University in Chicago and a member of the American College of Cardiologists’ prevention committee.
For the first time, the study showed how raising HDL is likely as important as lowering LDL when it comes to reducing the risk of heart attack, Rosenson said.
And just as too many Americans have high levels of so-called bad cholesterol, too few have low levels of good cholesterol. The latest statistics from the American Heart Association show that as many as one in three adult men and one in 10 adult women have low HDL cholesterol.
Therefore, “the next big hope is raising HDL,” said Dr. Greg Brown, a cardiologist and professor of medicine at the University of Washington in Seattle.
Drug May Offer Hope
Hope may lie with a new drug, torcetrapib, that raises HDL. It has not been approved by the Food and Drug Administration, but Dr. Steven Nissen said the trials of the drug were “one of the most watched.” He is interim chairman of cardiovascular medicine at the Cleveland Clinic and president of the American College of Cardiology.
“If [torcetrapib] works, it’ll be a revolution,” said Nissen, who’s also the principal investigator in an ongoing trial of the medication. Early trials of the drug have resulted in a 50 to 60 percent increase in HDL levels, he said.
Torcetrapib may raise blood pressure slightly in some patients, though, which is an unwanted side effect when trying to reduce risk factors for heart disease, Rosenson said.
Also, it is not yet known how effective torcetrapib will be at reducing the risk of heart attack, Nissen said.
The drug has received a lot of press already in part because of controversy raised when Pfizer, its manufacturer, said initially that it would market torcetrapib ony as a combination pill with Lipitor, a cholesterol-lowering drug.
But this week The New York Times reported that Pfizer had reversed its decision and now plans to make it available as a stand-alone drug as well.
What About Niacin?
Even though torcetrapib won’t be approved until 2008 at the earliest, there are already medications on the market that are effective at raising HDL. Niacin, or vitamin B3 in high-dose form, is one that raises HDL by about 30 percent, Brown said.
In spite of its effectiveness, niacin isn’t prescribed very often by general doctors, said Dr. Roger Blumenthal, director of the Johns Hopkins Ciccaroni preventive cardiology center and spokesman for the American Heart Association.
That’s because it often causes flushing, or heat flashes, in patients. Although it’s effective, many doctors don’t prescribe it, because it requires counseling patients on side effects and adjusting the dosage many times, Brown said.
While some patients can’t tolerate niacin, the side effects do go away after two to three months of continued use, he added. Also, drug manufacturers are developing newer preparations of niacin that minimize the side effects and may become available next year, Blumenthal said.
Lifestyle Changes Work, Too
For patients at high risk of heart attack and strokes, some preventive cardiologists have been fairly aggressive about treating low HDL. But Blumenthal said that cholesterol guidelines for general physicians have focused more on lowering LDL than on raising HDL and that the evidence for them to aggressively treat low HDL isn’t yet available.
But, if you are interested in increasing your good cholesterol, there are a number of things you can do, doctors said. Not surprisingly, they are what doctors always advise â€” get more exercise and eat better.
First, lose weight if you are overweight, Brown said, because overweight or obese people are likely to have lots of bad and not enough good cholesterol.
Regular exercise also pumps up HDL levels. And, for those who smoke, quitting raises HDL levels as well â€” a result that can be seen in about 60 days, Rosenson said .
Altogether, the lifestyle changes can raise HDL by about 20 percent, he added.
As for dietary recommendations for elevating HDL, Rosenson said fish, walnuts, almonds and avocados all have monounsaturated fats, which can help raise HDL slightly, although he recommends them in moderation.
Lifestyle changes are important, doctors said, not only for improving HDL but for overall improvement in cholesterol and health.
But, said one dietitian: “There is no magic cereal that will suddenly improve cholesterol. However, eating high-fiber cereal is a great way to start your day.”