New research questions the benefit of drugs to raise HDL, but lifestyle steps to boost good cholesterol are still recommended.
One of the fundamentals of heart-healthy living is that if your LDL (bad) cholesterol is high, you need to take steps to lower it. After all, bad cholesterol contributes to artery-clogging plaque deposits. On the flip side, doctors encourage us to also raise our HDL (good) cholesterol. That’s because people with high HDL tend to be at lower risk of heart disease.
The HDL story became more complicated after findings from a recent Harvard study. Researchers pooled health information on more than 116,000 people genetically predisposed to produce higher-than-normal amounts of HDL. Surprisingly, this group did not show the predicted 13% lower risk of heart attack, which undermined the rationale for prescribing drugs to boost HDL.
“The study results suggest that just because an intervention raises HDL cholesterol, we cannot assume that the risk for heart attack will drop,” says Dr. Sekar Kathiresan, one of the lead researchers on the gene study and an associate professor of medicine at Harvard-affiliated Massachusetts General Hospital.
Fortunately, the heart-healthy lifestyle that tends to raise HDL and lower LDL is still good for us. Here’s what the new science results mean for you.
HDL: Why we care
HDL cholesterol is thought to be healthy because it transports fat from the arteries into the liver for disposal or recycling. People with HDL levels above 60 milligrams per deciliter (mg/dL) tend to have a lower risk for heart disease. Not unreasonably, doctors and scientists assumed that deliberately boosting HDL would lower cardiac risk even more — much the same way that lowering bad cholesterol does.
A number of clinical trials have tested new drugs for raising HDL cholesterol, but so far the results have been disappointing. Currently, several medications can be used to raise HDL. However, the ultimate benefit of doing so remains unclear — especially when compared with the clear benefit of lowering LDL using statin drugs.
Reconsidering HDL drugs
Medications have potential side effects and aren’t free, so when research undermines the benefit of a drug, doctors may reconsider its use. “We should stop prescribing drugs that have the sole purpose of raising HDL cholesterol until such drugs have been proven to reduce the risk for heart attack,” says Dr. Kathiresan.
While scientists figure out whether raising HDL with drugs is warranted, you should continue to pay attention to HDL. If it’s on the low side, take the usual steps to raise it, such as increasing exercise, quitting smoking, losing weight, and eating a vegetable-rich diet. Raising your HDL with a healthy lifestyle will reap benefits. “HDL is a good marker of successful disease prevention strategies,” says Dr. Eric B. Rimm, a member of the large team involved in the gene study and an associate professor of medicine at Harvard Medical School.
Also, nothing has changed with respect to bad LDL cholesterol. High LDL increases the risk of heart attack, and lowering high LDL can decrease this risk. For every reduction of 40 mg/dL in LDL, cardiac deaths drop 19%.
The dream of HDL-boosting therapy is still alive, and one large clinical trial is ongoing. In the meantime, targeting LDL still provides the most heart healthy “bang” for your buck.
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