Overcoming low HDL

Dear Doctor:

I am a 34 year old male in good health other than benign PVC's and a 4 hour episode of A-Fib that happened two years ago. It was due to daily consumption of two glasses of red wine that lowered my magnesium levels. No more episodes since quitting drinking and taking Magnesium oxide. However, I was drinking the red wine to raise HDL as it was in the 24-33 range.

My doctor and I have devised a plan to keep my LDL and total cholesterol as low as possible as to keep my ratio of Total cholesterol to HDL as low as possible. I am unable to take Niacin as I have severe acid reflux and cannot tolerate it. I take 20 mg of Zocor a day, exercise 40 minutes a day six days a week and drink 12 ounces of Welch's purple grape juice a day. My most recent Lipid profile is as follows:

Total Cholesterol-116
Triglycerides-126
LDL-61
HDL-32
Ratio-3.6

My question is do you think I am doing the prudent thing considering my circumstances? Am I at a decreased risk of CAD since my low LDL makes up for my low HDL. I figure I can follow this program until they approve an HDL elevating drug. Also, do you know when those new CETP Inhibitors should be on the market?
Thanks for your time.

Sincerely,

Erik

[CCF-M.D.-RCJ]

Erik,

Thanks for the post.

With the information that you have provided, you do not meet criteria to initiate drug therapy for your cholesterol profile.  The National Cholesterol Education Program recently released the ATP III (http://hin.nhlbi.nih.gov/ncep.htm), which discusses LDL and HDL goals.

I cannot say that what you are doing is either "prudent" or imprudent, but it is an aggressive therapy program, and one not currently endorsed by the medical guidelines.

The low LDL does lower your risk for coronary artery disease, but I cannot say if this low level of LDL completely offsets the pro-CAD effect of the low HDL.

I have not heard when a CETP inhibitor may be released, but I think we may expect to see one on the market within the next two years provided that the studies support their release.

Hope that helps.

[heartbeat]

I don't know, Erik, why you worry about your cholesterol.  Your numbers are great, even your HDL is within normal range, (normal 30 - 90) Also your ratio is great.  I wished I had your numbers. I have high cholesterol for many years now, I'm also on 10mg Zocor. My HDL is 72, nice high number, but also all my other numbers are high. Total 233, LDL 125 Trig. 264.
Laura

[Dr. Erik]

Your ratio is 3.2 which is even better than mine. Your LDL is borderline high but not bad. Just your Triglycerides are a little high. You may need a higher dose of Zocor.

[heartbeat]

My Triglycerides usually is around 150 - 175. At my last checkup it had jumped to 264, I don't know why.  Because of my high HDL my ratio is good, that why I think the 10 mg Zocor is enough.  My doctor checks my blood every 4 month.Laura

[hbp702]

I suggest you get checked out for diabetes. Diabetes and pre-diabetes and insulin resistance are associated with high triglycerides and low HDL. These changes often show up before the pancreas has been damaged enough to cause diabetes (or possibly even before the pancreas has been damaged at all)- so it might be an early enough warning to stop type 2 diabetes from occurring.

Once diabetic, always diabetic, and once you hit that point, damage (to the pancreas and the rest of the body) occurs inevitably, even with PERFECT glucose control (which you won't be able to maintain, as more and more beta cells die).

Stop diabetes before it attacks. Exercise (with medical permission).

Diabetes is worse than heart disease in my opinion. It kills you bit by agonizing bit. And it is relentless. I've seen it firsthand (thankfully I personally have avoided it).

I'd take dying from VFib before dying from diabetes any day.

[heartbeat]

My doctor, who takes a blood test every four months, is an Internist who specializes in hypertension and diabetics.  Therefore, I'm sure he watches for diabetics due to my high trig.
But thank you for the warning.
Laura

[HealThySelf]

Familial HDL deficiency is a ***** and a killer.  I'm sure that there will be a one shot genetic treatment in 10 years, but it would cost the drug industry about 50 billion a year so I don't think they will rush it.

The three current things proven to raise HDL are exercise, alcohol, and high dose Niacin.

When I had my heart attack 4 years ago my TC was 220 and my HDL was 29.

Now thanks to a combination of Lipitor + Welchol + Niaspan my TC has been between 110 and 131 over the last year.  Problem is that my HDL was only 38 six months ago.  Fortunately it had moved up to 45 on my last test, I think mainly due to Niaspan + exercise.

Your readings are quite good otherwise, except maybe triglycerides are a bit high, and it would be quite hard to have high HDL with those low overall readings, but you should be able to obtain 45.

You said that you couldn't tolerate Niacin, but have you tried Niaspan?  I take it on an empty stomach at bedtime -- no low fat snack like they recommend -- that's bogus advice.  I never have a problem unless I eat too close to bedtime - then I might experience flushing.  The pill itself is so highly buffered that it shouldn't cause any irritation to the stomach.

Also I try to walk uphill about 5,000 feet per week during the summertime and a bit less during the winter.  Fortunately I live in the mountains, but even 15 minutes of walking uphill a day really makes a difference.

Good Luck.

[Dr. Erik]

I have not tried Niaspan. I just thought that with acid reflux that the Niaspan could make it worse. I could be wrong. Do you really think my Triglycerides are high at 126? Thanks for your comments.

[HealThySelf]

If I were you, I would ask the doctor for a Niaspan script.  I think that you could take it without a problem on an empty stomach at bedtime.  That and daily exercise would be about the best thing that you could do for your HDL.

I think that the triglycerides are a bit high for the total cholesterol levels that you are showing.  The standard is anything below 150 being acceptable, but I would think that you shouldb be down around 100 with that TC.

Of course I'm not an expert, just someone trying to save myself from advanced coronary artery disease.

Regards