HDL Therapy Makes National Headlines

Everyone talks about LDL cholesterol—it’s on TV commercials, drug companies make billions from treating it. But there’s tremendous power in HDL.
 

…there is no evidence from experimental studies or clinical trials to establish that low HDL levels are causally important in atherogenesis.

- Dr. B. Lewis, St Thomas's Hospital, London; 1983

Dr. Lewis’ skepticism of the lack of value of raising HDL was the prevailing view back in the 80s. Back then, LDL cholesterol commanded center stage. Forget about HDL—not enough information.

We’ve come a long way since then. It’s becoming clearer and clearer that pushing HDL up is not only a way of reducing risk, but regressing plaque. HDL scavenges cholesterol from plaque. The Apo A1 Milano experience helped validate the concept of HDL as a plaque-reducing particle.

We’re now on the cusp of some exciting new possibilities for dramatically improving HDL. The USA Today article is an example of how mainstream this conversation has become.

Raising HDL Cholesterol and HDL Subclasses

A low HDL is the most common cause for heart disease (usually accompanied by small LDL particles, too). What’s low? Views differ, but we regard any HDL <60 mg as too low and a contributor to plaque growth. Less than 10% of people with coronary plaque have HDL>60 mg—it’s an epidemic!

For Track Your Plaque, we aim to raise HDL to 60 mg/dl or greater. This appears to be the minimum level necessary to gain control of your score.

Until we have some of the new therapies like torcetrapib (or if you’d like to avoid these new medications), how do you raise HDL?

Raise HDL by:

• Choosing foods rich in monounsaturated fatty acids (raw almonds, walnuts, pecans; olive oil and canola oil), selecting low-glycemic index foods (less sugar-raising), and increasing protein intake. Remember that high-glycemic index foods are unhealthy yet cleverly disguised as healthy—wheat products like Shredded Wheat cereal, Raisin Bran, and whole wheat bagels.
• Exercise raises HDL. Usually good for 2–4 points. Combining exercise with weight loss if you’re overweight can really boost HDL through the roof. It’s not uncommon to shoot HDL up 20 or more points when you return to ideal weight.
• Fish oil—Omega-3 fatty acids can raise HDL, especially if triglycerides are >200 mg. Our minimum dose is 4000 mg per day (providing 1200 mg omega-3 fatty acids). Fish oil is actually much more effective for correcting the multitude of lipoprotein abnormalities that usually accompany low HDL (small LDL, increased VLDL, etc.) but it’s still helpful for a modest boost in HDL.
• Niacin—The majority of successful participants in Track Your Plaque use niacin to boost HDL and correct associated patterns. Remember, niacin is vitamin B3. Substantial effects usually begin at 500 mg per day, though some people show a response as low as 250 mg per day. When exceeding 500 mg/day, niacin is best prescribed by a physician with experience in dealing with the peculiar effects of niacin (most of them harmless), like feeling hot and itchy. Slow-release preparations are available but consult your doctor in choosing forms that have been proven to be safe. Our preferred forms are Niaspan® (Kos Pharmaceuticals) and Slo-Niacin® (Upsher-Smith).
• Wine—Red wines like Shiraz/Syrah, Cabernet Sauvignon, Merlot, and Pinot Noir contain the fabulous flavonoid, resveratrol, with powerful anti-inflammatory effects. It also boosts HDL several points if you don’t exceed two 4 oz glasses per day.
• Chocolate—A Penn State University study showed that a combination of 22 grams of cocoa powder and 16 grams of dark chocolate per day (providing 466 mg of chocolate procyanidins) raised HDL 4%. It’s not much but such an easy, delicious way to do it! Don’t overdo the chocolate, of course, since a substantial quantity of saturated fat and sugar come with the good stuff. Look for dark chocolates with cocoa or cocoa mass, not sugar, listed as the first ingredient.

Other prescription treatments your doctor might consider include cilostazol and the thiazolidinedione class of pre-diabetes medications (Actos®, Avandia®)—at least until some of the new HDL-boosting agents become available.

In the meantime, Track Your Plaque will continue to monitor these therapies to gauge their usefulness and relevance to plaque regression. To read further, see our article ApoA-1 Milano: Hope for a Cure or Hype for Profit?

An update on two other promising HDL increasing drugs, torcetrapib and CETP inhibitors, is also coming to Track Your Plaque in the near future.


Selected references:

Wan Y, Vinson JA, Etherton TD, Proch J, Lazarus SA, Kris-Etherton PM. Effects of cocoa powder and dark chocolate on LDL oxidative susceptibility and prostaglandin concentrations in humans. Am J Clin Nutr 2001;74:596–602.

Ikewaki K, Mochizuki K, Iwasaki M, Nishide R, Mochizuki S, Tada N. Cilostazol, a potent phosphodiesterase type III inhibitor, selectively increases antiatherogenic high-density lipoprotein subclass LpA-I and improves
postprandial lipemia in patients with type 2 diabetes mellitus. Metabolism. 2002 Oct;51(10):1348-54.

Elam MB, Heckman J, Crouse JR, Hunninghake DB, Herd JA, Davidson M, Gordon IL, Bortey EB, Forbes WP. Effect of the novel antiplatelet agent cilostazol on plasma lipoproteins in patients with intermittent claudication.
Arterioscler Thromb Vasc Biol. 1998 Dec;18(12):1942-7.

Copyright 2006, Track Your Plaque.