Question from AKS21

Needed to repost this question since it accidentally had personal information in the subject from the user. It wasn't answered previously, so is not a duplicate. Here is the question:

Member: AKS21

Increasing HDL

I suffered from unstable angina back in January of 2005.  An angiogram performed in Jan2005 revealed a 99% blockage in the LAD and a 90+% blockage in the RCA.  Both were stented with Taxus DES.  A third blockage in the circumflex was in a very small distal part of the vessel and hence was left alone and nothing was done to it.    I am now 50 years old 6ft 175 lbs.  
My last lipid panel was as follows:  Total Cholestrol 98,  Triglycerides 94,  HDL 32,  LDL 47,  CK 174.
My current medications:  Lipitor 40mg,  Plavix 75mg,  Bisoprolol 2.5mg, Asprin 81mg.

Inspite of all my efforts with exercise 1 hr 5 to 6 times a week, low fat diets etc I have been unable to increase my HDL to a acceptable level above 40.  So my cardiologist recently started me on Niaspan 500 mg .  When I look at the formula for  LDL =TC-HDL-.20( triglycerides)  I find it difficult to see how I can raise my HDL without raising my TC above 110 or by further reducing LDL to under 39 or reducing triglycerides to some really absurd number .  Is my logic wrong in this case or is there any other way of raising HDL number.

My question is is it even worth it with all the medications that I am on now to try to raise this HDL number by adding another medication Niaspan or am I genetically disposed to this low HDL and should not worry about it  anymore.  Your opinion or insight would be greatly appreciated.

[Darcy Green Conaway, MD]

It turns out that a study looked at this and was just published this month in The New England Journal of Medicine. It found that in people like you, who are already on a statin and have low HDL, that increasing the HDL helped prevent further heart attacks/stroke. There are on-going outcomes studies regarding the use of statins and niaspan in combination.
This is a great question-- sounds like you have a fantastic physician!