Q: I exercise five days per week, take Zocor and eat a healthy diet, but my HDL cholesterol level is still 34. The rest of my lipid profile is excellent. I'm considering taking 500 mg of no-flush niacin that I get from a health food store. I'm a 72-year-old man (6 feet tall and 190 pounds). Any suggestions on how I can boost my HDL and decrease my risk for heart disease?
A: I understand the concern over your high-density lipoprotein (HDL) level of 34, as the low result is a risk factor for heart disease. Fortunately, there are strategies to boost your HDL, including higher doses of the B vitamin known as niacin. But don't take this medication on your own, as it has the potential for unwanted side effects and should only be used with the guidance of your physician.
What is HDL and why is it 'good'?
HDL is known as the 'good' type of cholesterol. The more you have, the better chance that you can prevent or decrease the build up of plaque in the arteries. That's because HDL acts as a 'sweeper' and 'keeper' of those fatty deposits. Essentially, HDL takes LDL cholesterol deposits off the artery walls and transports them to the liver, where the bad stuff is metabolized and removed from the blood. If the level of HDL is low due to factors like heredity, trans fats in the diet, smoking, type 2 diabetes, or inactivity, the risk for heart and cardiovascular disease goes up in an individual with a high total or LDL cholesterol level. In other words, HDL is one of several types of cholesterol, fats or particles in the blood (triglycerides, LDL cholesterol, Lp(a), Apo B, others) that are monitored to better assess cardiac risk.
Now that we know why HDLs play a role in heart health, let's discuss your situation. You are currently on Zocor, a statin class of cholesterol-lowering medication that also has the ability to raise HDL. Given that your current level is 34 mg/dl (milligrams per deciliter), a good first target for you is 40 mg/dl to 59 mg/dl.
Don't get discouraged if it takes a few months to get there. The good news is that for every one mg/dl increase in HDL, there is a three percent decrease in the risk for heart disease. If you obtain a HDL level of 60 mg/dl or above, that would be a bonus and may provide further protection again the development of atherosclerosis.
The following lifestyle choices can be used to increase HDL:
- Weight reduction in those who are overweight. To put this into perspective, every 10 pounds of weight loss (not water weight) may lead to a 1.5 to 2 point rise in your HDL.
- Diet modification. Say yes (in moderation because of calories) to foods containing healthier fats (nuts, fish, avocado) and oils (canola, soybean, olive). Minimize or eliminate foods containing trans fats (products containing partially hydrogenated vegetable oil, others) and saturated fats.
- Increased activity. Engage in 30 minutes of aerobic activity (with clearance from your physician) at least five times per week. This may increase HDL by up to five points.
- Smoking cessation. Kicking the smoking habit will do more than decrease your risk for lung cancer, it'll also help protect your heart and cardiovascular system. In fact, quitting tobacco may raise your HDL by four points or more.
- Add fiber. Include fruits, vegetables, nuts and whole grains to your diet.
- Minimize simple carbohydrates. Foods like cake, cookies, highly processed cereals, and breads can lower HDL and raise triglycerides.
If the above measures don't budge your HDL into the healthier range, supplements containing plant sterols (beta-sitosterol, etc) and omega-3 fatty acids may be considered. Medications can also be used to increase HDL and include the following:
- Niacin (vitamin B-3) in higher doses (500 mg to 2 grams) may increase HDL 15 to 35 percent. Formulations are available with or without a prescription, but due to the potential for harmful side effects (interactions with other medications and alcohol), you should consult with your doctor.
- Fibrates (fenofibrate, others) may increase HDL by 20 percent.
- Statins (atorvastatin, rosuvastatin, others) may increase HDL by 15 percent.
- Combination medication containing a statin plus niacin, such as Advicor or Simcor, may increase HDL by up to 50 percent.
Back to the basics
It's clear that you're motivated to take charge of your health, so let's discuss body mass index (BMI) and waist circumference. The location of fat (waist circumference) and the relationship to your height and weight can provide clues to the potential for additional cardiac risk factors. Though BMI is not a perfect measurement for all people, it's a good starting point for most individuals when discussing HDL.
First, let's calculate your BMI. At six feet tall and 190 pounds, your BMI calculates to 25.8, which is considered overweight. This is important because the higher the BMI, the more negatively it impacts HDL. A good first approach is to decrease your weight and aim for a BMI to a range of 18.5 to 24.9. A registered dietitian can help with this goal.
Next, measure your waist. This is important because the location of your fat on the body can add to your health risks. For males, a waist circumference of 40 inches or more (35 inches and above in women) suggests a higher likelihood for developing heart disease.
Putting it all together, HDL is an important factor in the evaluation of cardiac risk. However, it doesn't represent the whole picture, for which you'll need to consder genetics, lifestyle choices, activity level, your current state of physical health, and your emotional well being.
More on Heart Health from MSN Health & Fitness
- Cholesterol Levels: What Numbers Should You Aim For?
- Trans Fat: Avoid This Cholesterol Double Whammy
- Search: Good Cholesterol
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