Raising HDL

[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 55 I am wondering if this is achievable or not.    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.

[Healthyself2]

A couple of other thoughts:

I wouldn't be too concerned about TC.  I've intentionally tried to keep mine at 150-160 with a 3:1 ratio of TC:HDL.  I believe that LDL has a purpose and I don't want to drive it down too far as I did in the early days of treatment.

I believe by combining drugs you can use less of each one.  The three that I use all work differently.  I believe the lower doses of each are likely to give you less side effects and less potential for liver damage.   I wouldn't want to just depend on a statin to perform the miracles needed - I want to cover all of my bases.

Also I took a monthlong round of a frontline anti-biotic in the early days, based on the possibility that my plaques were full of bacteria.   Maybe not a wise thing to do, as it killed every bug in my body, including the good ones, but it may have helped stop my disease.

[Healthyself2]

I've used a cocktail of Lipitor + Whelchol + Niaspan for about 5 years, and was taking just Lipitor before that.   My HDL was always around 30, but has now been consistently in the 50's and my TC, LDL, and TG readings have always been ideal.  Fortunately I have a good liver.

I have also treated by BP agressively with a CCB and ACE inhibitor in combo.  BP and long standing out of wack lipids are the main root causes of CAD.

I have a ruptured plaque in my left main, a longstanding total occlusion of the RCA and other coronary vascular artifacts.  I was given a 40% chance of death within 5 years by the last doc that looked in there, if I refused CABG - which I did.

Bottom line is that my disease seems to be in total remission.  I got in a bad situation a few weeks ago while snowmobiling with a friend.  We had both machines stuck off trail in deep snow.   There was a lot of fear and heavy exersion, which would normally cause me angina in the past.  I was very tired by the time we got out, but no angina.  I started thinking that I have not felt angina in about 2 years.

Other than the drugs, I walk a lot, and believe walking up and down hills is as important as the drugs.

BTW, I used to take 2 x 750mg Niaspan, but now take the 1000mg, which seems to do as well and is more tolerable.  I take the whole mess of pills at bedtime, which seems to be the most effective time of day to take them.

Good Luck.

[TerryH]

Fruit Pectin Cholesterol Cure

I was diagnosed in June '07 from a May blood test.  Doc said it was hereditary and there was no dietary fix to be had.  Prescribed Lipitor at $3./day for the rest of my life!  I numbly bought the pills but Googled the drug before taking.  There is a 5.6% rate of severe muscular degeneration!  I never took them out of the wrapper.
Further Googles turned up an array of natural treatments but only one had scientific studies attached to a great deal of anecdotal evidence - FRUIT PECTIN.  The study was on pigs and the grapefruit rinds cured them.

5 months later all 5 indicators read NORMAL!...whereas all 5 were badly out of whack back in May.

The Cure:  Buy liquid fruit pectin, same as for jam and jelly making.  I found Certo brand at the Superstore for $3. a box which lasts about 3 weeks.  Mix 1 teaspoon with juice.  I like veggy juice or orange.  Take once a day for the first week and then 3 times per day hence.

Note that since my condition is hereditary I did not attempt to alter my eating habits at all.  I am a fit and trim man and have modified my eating habits decades ago to maintain appropriate weight to height ratio.

Now that I am 'cured' I will drop my pectin intake to 1 teaspoon/day.  In Jan'08 I will be tested again to see in the lower maintenance dose is effective.

Good Luck to All,
Terry

PS:
Take responsibility for your own health by educating yourself.
Don't trust Doctors.  They are paid directly by drug companies.
Do not accept advice, carte blanche, from people without names.

[MysteryChemist]

It will be interesting to see what the doctor says.

Niapsan can reduce your LDL, and tri, as well as increase your HDL. I am not a doctor, but what everything I have read it is worth to do what it takes to raise the HDL.

My cholesterol numbers were like yours a couple of months after I had had a heart attack. (I got a stent in the circumflex) I was on 40 mg of Lipitor, 2 X 6.25 mg Coreg and 2.5 mg Lisinopril, 1000 mg X 2 of fish oil, and aspirn. After 4 months, my total cholesterol was 112,  triglycerides 118, hdl was 31, and LDL was 57 with the Lipitor and low fat diet. My Dr added Niaspan. My dose was eventually upped to 2000 mg a day.  My numbers are now,

Total 95, HDL 45, LDL 42 and tri 38.

I saw no effect on HDL until I was bumped to 1500 mg of Niaspan. (My lipitor dosage was cut back to 40 mg one night, 20 mgs the enxt night as my LDL was 31.  My PCP thought my LDL was a little too low.)

My HDL has always been 32-33, going back to 1990.  (I am 55) I quit smoking, started jogging 6 days a week, watch my diet- nothing helped me.  All of the traditional advice did not help me. (It works for other people but it didn't help me. I felt very frustrated)  Even cutting out all trans fat after my heart attack did not help my HDL.

While I can understand your releuctance to add more pills to what you take, Niaspan can help.I would suggest giving it a try.  You can always stop it.  I should mention that the most common side effect is flushing.  I have had only 1 or 2 incidents in the 18 months that I have been on Niaspan.

I realize this sounds like a commercial for Niapsan, but it really helped me raise my HDL.

[Cleveland Clinic]

Current randomized clinical trial evidence suggests that lowering  LDL protects from the development of ischemic heart disease, both as a primary event and secondary coronary events ( that is in preventing second and third events from occurring after the first event has already occurred). There is no randomized clinical evidence (evidence of the highest caliber) to suggest that raising HDL with Niaspan decreases the primary or secondary rates of ischemic events, but observational data ( that is long term followup of non randomized patients, and hence data of lower quality) suggests a stronger linkage between HDL and ischemic heart events. The truth is that low HDL and high triglyceride levels may actually be a better marker of coronary atherosclerosis than LDL levels, but Niapsan even though i raises the HDL level does not seem to reduce to longevity of people with mild decreases in HDL.
There is a randomized trial with Gemfibrozil called the VA-HIT trial which included only men which had coronary artery disease with low LDL and  HDL and elevated triglycerides. It showed at 5 years a statistically significant decrease in cardiovascular death in the patients treated with gemfibrozil 1200 daily.
Another trial called BIP, which studied a related medicine to Gemfibrozil  showed a non statistically decrease in the combine endpoint of cardiovascular death/MI or need for coronary intervention in patients with low HDL, high LDL and history of myocardial infarction with continued anginal symptoms.
The bottom line seems to be that medications such as Niaspan are advised to be used in patients with low HDL and coronary artery disease. Other interventions may include switching the Lipitor to Crestor, which does not decrease the HDL to the same level as Lipitor, dietary and lifestyle modifications, or medications such as Gemfibrozil.benzofibrate/fenofibrate, whcih actually have some proven clinical effectiveness. The reason we don't routinely use them in patients already on Statins, is the increased event rate of myopathy and hepatitis.