Strategies for raising low HDL

Posted by Robert Baird on April 25, 1999 at 09:20:36
I am a 55yo male with family history of heart disease, BMI=20, typical BP 120/80, not diabetic, quasi-sedentary, quit smoking 1/99.  Typical cholesterol has been HDL under 35, total 200.  Five weeks ago I had a MI and angioplasty for two 100% blockages. I have several blockages of 40-60%. Cholesterol test in hospital was HDL 34, LDL 137, VLDL 28.  After 30 days on Ornish diet and 10mg Lipitor, my cholesterol tested HDL 22, LDL 87, VLDL 19.  My HMO's primary care doctor suggests exercise for raising HDL.  Though I recognize the many benefits of aerobic exercise, my understanding is that it is not likely to raise HDL more than a few points.  How much should I aim to raise HDL and improve the HDL/LDL ratio?  What's my best strategy for doing that? [My only other med is 50mg daily metoprolol.]

Posted by CCF CARDIO MD - MTR on April 27, 1999 at 15:50:54
Dear Robert, thank you for your question.  I understand your concern regarding your HDL level since you certainly want to do whatever you can to make sure your coronary disease stays quiescent.  Lipitor is one of the few lipid lowering medications that is known to raise the HDL level (by a modest 5%).  Normally,  we wait for 3 months after starting a medication like lipitor before rechecking the lipid profile, so it may be too early to determine the true effect of lipitor on your HDL level.  Moderate, sustained aerobic exercise is known to raise HDL levels, but that also takes time to see the results.  Women are protected with estrogen, which is another thing associated with increased HDL levels.   There also is some anecdotal information that 1-2 glasses of red wine a day raises the HDL level, but that has never been proven.   Therefore, I suggest that you speak with your physician regarding an appropriate exercise program, continue with the excellent diet you've started, and continue with your medications.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.  Good luck!
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart
Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
Posted by Dan on April 28, 1999 at 17:18:42
Hi, I've heard that high doses of Niacin can lower
LDL and raise HDL significantly, although blood
tests should be used to monitor the liver when taking
high doses of Niacin.
Any comments on this?

Posted by CCF CARDIO MD - MTR on April 29, 1999 at 16:27:46
Dear Dan, you are correct.  Niacin can raise HDL levels, but it is a poorly tolerated medication that cannot be used by many patients.  I believe it's always worth trying niacin, but patients should also continue to exercise daily and eat a low fat, low cholesterol diet.