Should low HDL be treated or not?

[Dr. Erik]

Hello Doctor:

I have had persistantly low HDL between 29-40 for the last five years. I am a 35 year old male otherwise healthy with the exception of PAF and PVC's and PAC's. I take Cardizem and Toprol so the PAF is under control. I have been on Zocor for the past two years to minimize my risk for CAD. I have tried exercise and weight loss and the highest my HDL has gotten is 40. My LDL usually runs between 50-80 and total cholesterol between 120-140.My ratio of total cholesterol to good cholesterol is usually around 3.5 and my Blood Pressure is usually 117/70. I continue to exercise. I can't drink red wine any more because it started my A-Fib. I want to be very aggressive in preventing CAD. I can't wait until the CETP inhibitors are released!

My questions are 1)should I be doing moore to raise my HDL? 2) Am I at significant risk to have a heart attack?(parents and siblings have no CAD, Grandfather had heart attack in his 40's and bypass in his 70's and is still alive)   3)Will your center be participating in the phase 3 clinical trials of Torcetrapib and if so can I enroll?

Thanks for your time!!!! You doctors provide an invaluable service. Hope you have a nice Easter and Passover!!!

Erik

[007Arb]

I have been on a mission to raise my HDL.  That's primarily because of longevity studies I have seen that says one commonality among the long lived is extremely high levels of HDL.  Not sure what qualifies as *extremely* high but I would guess 65 to 75 in men and 75 to 90 in women.   So far I have raised my HDL from the low to mid 50s to the 68-70 area and hoping to get closer to 80. My ratio of total cholesterol to HDL is 2.6.  I can't quite pinpoint how I raised my HDL. I increased my weekly running from 20 to 30 miles, I increased my niacin intake from 500 mg to 1000 mg daily,  I began drinking a beer a day, and I begin eating lots of raw peanuts daily.  One thing I have learned is what works for one person may not work for another.

[Clenn Camp]

Barlean's is the best brand of flax seed oil.

Glenn

[nmc]

Hi again Eric:
I am currently using flax seed oil softgels (1000 mg) and 1000 mg of fish oil. I've also used flax seed (sprinkled on my yogurt or cereal), but am just going with the easy-to-use soft gels right now. If you're concerned about coronary artery disease, my cardio also recommended folic acid. I'm also on Lipitor, so have added Coenzyme Q-10 to my diet. My supplements have almost become a meal in themselves, but at least the results are tangible, so I'll continue with the program. Best of luck to you!

[Healthyself2]

I would suspect that Niaspan would be neutral on arrythmia problems.

I did have some troubling PVC or PACs (don't know which is which) after my heart attack, when I would begin exercise.  They went away with time and my medications have had no negative effect.

I don't know what your risk is, but I would say that someone with HDL 55 or above, and a good ratio, and who does some mildly aerobic exercise every day is at extremely low risk for CAD.

With respect to the Niaspan, I found that the best way to take it (and all my cholesterol meds for that matter) is before bedtime with no food or alchohol at least 2 hours before.  I have had no problems with flushing, taken that way, and the meds seem to have the best effect.

Regards

[Dr. Erik]

Thanks for your comments! I completely agree with you on the HDL factor in CAD. I am seeing my doctor in one week and I am going to ask him about putting me on Niaspan along with my Zocor. My ratio is good but I would feel better about getting my HDL up in the mid 50's like you said. By the way, have you ever had PVC's, PAC's or any arryhtmias? I have them and have had some A-Fib. I just worry that Niacin will irritate my heart rythm.It's worth the risk in my case I think. What do you think about the Doctor's opinion on this forum that my chance for a Coronary event in the next 10 years is less than 1% seeing that I am only 35 and have normal blood pressure with a good Total Chol/HDL ratio?  

Thanks again!

[Healthyself2]

I believe that HDL levels are probably the best predictor of future coronary disease.

I have familial HDL deficiency and 3 vessel coronary artery disease.  Prior to treatment my HDL was 29.  My last reading was 55 with a total cholesterol of 150.

I got the 90% improvement the hard way by walking uphill every day (up to 10,000' per week in the summertime) and taking Niaspan, which is like killing a fly with a sledge hammer, but there is currently no better drug on the market.

I do have high hopes for the CETP inhibitors and probably will switch from my 3 meds to the Lipitor + torcetrapib if it makes it to market.  

In the meantime, I believe that my disease has been arrested, using the current drug regimine and daily exercise.

It may pay you to explore taking Niaspan to get your HDL up to at least the mid 50's.

Best Regards

[Dr. Erik]

Thanks for the information! Do you you use flax seed or flax seed oil? Also, how much of the flax seed and the fish oil do you take per day? It is definitely worth a try! Thanks again!

Erik

[Dr. Erik]

Thank you very much for the information!

[nmc]

Hey Eric:
I too struggled with ways to boost my HDL numbers (range 27 - 40). I'd read that flax seed and fish oil (Omega-3) might have some impact, so began using both. The latest lipid profile showed a good increase in HDL (57), which I can only attribute to these two dietary supplements. May not work for everyone, but I'm glad I gave it a shot.

[CCF-M.D.-RCJ]

Erik,

Thanks for the post.

Q1:"should I be doing moore to raise my HDL?"

No one can answer this question for you.  The available evidence does not support an answer either way.

Q2:"Am I at significant risk to have a heart attack?

From the information provided, your 10-year risk of having a heart attack is less than 1%.

See http://www.nhlbi.nih.gov/guidelines/cholesterol/ for a risk calculator.

Q3:"Will your center be participating in the phase 3 clinical trials of Torcetrapib and if so can I enroll?"

Steve Nissen is running an imaging trial (meaning an IVUS trial) for Pfizer involving this drug (see http://www.forbes.com/sciencesandmedicine/2004/02/25/cx_mh_0225cetp.html).  However, given your low-risk of having an event in the near future, you would be unlikely to meet inclusion criteria for a clinical trial.  IVUS involves having a coronary angiogram, by the way.

Happy Easter to you as well.