Persistantly low HDL

[Dr. Erik]

Dear Doctor:

I am a 33 year old male. I have had a persistantly low HDL level. I have tried everything from diet including red wine, and exercising for 40 minutes a day 6-7 days per week. The highest I have gotten my HDL is 34.  My blood pressure is normal. I just had my cholesterol levels checked again a few weeks ago. They are as follows:
Total Cholesterol-126
Triglycerides-136
LDL-69
HDL-30
Ratio-4.2

My cardiologst does not want to treat this. My inclination is to be aggressive in treating my cholesterol. I went to my Family Doctor and demanded he put me on medication for Cholesterol. Our options were Niaspan or a Statin. I am aware that Statins only modestly raise HDL levels. But because I have chronic acid reflux, I feel I could not tolerate the Niaspan. I decided to go on Zocor. My theory is that while it might not raise HDL too much, it would lower the other numbers even more and keep the Ratio of good to bad more in my favor. My questions are:  1)Do you think what I have chosen to do makes sense from a medical standpoint? 2) Are there other alternatives to what I am doing now? 3) Do you agree with my cardioloist  for not wanting to treat this?

[CCF-M.D.-CRC]

Dear erik,
Low HDL (good cholesterol) defined as <35 mg/dl is an increased risk factor for developing heart disease.  Exercise and diet changes (including a small amount of red wine daily) can help to increase HDL.   However, HDL is primarly determined by one's genes and these lifestyle modifications may not increase levels by very much.   In cases where it is determined that ************** is needed the best drug to raise HDL is niacin.  Statins such as Zocor may actually end-up lowering HDL.

The decision to treat or not to treat a lone low HDL is not clear-cut.  In your case your total cholesterol is so low that the HDL really dosen't have anywhere to go.  All medications can have side-effects and I think what your cardiologist feels is that the potential side-effects of the medications outweigh the potential benefits.  I don't think there is enough evidence at this time to say that ************** in your case is beneficial. However, there is no evidence saying that it is harmful either (besides cost and potential side-effects).  So the bottom line is that the decision to treat or not to treat is between you and your doctor.

[itsa48]

my husband has the same problem with the hdl, i didn't even know it could be to low until he said his was about a month ago, his is 34, which incrreases his risk. my total cholesterol is just the opposite and iam on lipitor, which brought mine all in to a normal range, but keep in mine were to high.
his doctor told him to eat more fish, do you like salmon?  good on the old george forman grill lol! he is not on any meds to raise his hdl, but to me being on zocor does not make sense, iam not a doctor but when i started the lipitor all my numbers came down, so wouldn't yours come down, all of them as well? good luck to you.

[JR]

Why in the world would you be concerned with numbers as low as those!?

[Dr. Erik]

My LDL, Triglycerides and total cholesterol are normal, but my HDL has always been low. This leaves me at a higher risk for heart disease despite the normal levels. I need to either raise my HDL or lower the other numbers even more to keep a good ratio.

[No Bypass / No Stents]

In that case, your best bets are Niaspan and exercise.  I have a familial HDL deficiency but have raised mine from about 30 to 48 so far with exercise and Niaspan.  I'm hoping to be in the 50's the next time that I am tested.

I think that low HDL is the best predictor of coronary artery disease.  In your case your other readings are low, so it may not be as much of a risk factor.

The current mininum normal HDL level has been raised to 40.

I am always amazed by people, such as my friend, who eats just about anything and has a HDL level of 91.  They say that it's also a good predictor of longevity and these are the people that live to be 100.

[itsa4847]

to peco
because a low number in the wrong place can be just as dangerous as a high number, when it comes to chlosterol

they both can cause heart problems, which i already have and we are trying to avoid in my husband.

so i pretty sure that is why people are concerned with these numbers as are we.

[ladymoose]

It seems that niaspan is the drug of choice to raise the hdl levels.  What else can I do to raise the levels of hdl?  They say fish has the omega 3 fatty acids and are a good source as well as red wine. Also, why does the doctor start someone at 500 mg a day and then up it over the next few months? They say mine is abnormally low for a 44 year old female, so why not the 2000 mg. a day from the start?  I worry about getting the levels up before menopause as a womans risk of heart disease increases at that time as well.  How long does it take to get higher levels of hdl?