HDL: Harder to Control Than Thought

by Craig Stoltz Health Writer

Most efforts to battle arterial clogging focus on lowering LDL, so called "bad" cholesterol. But higher levels of HDL, the good cholesterol, are also linked to better heart health. A new report shows that efforts to raise HDL with drugs have proven to be trickier, and riskier, than lowering LDL. Let's dig in.

Bottom line first

There's only sketchy evidence that using drugs to boost HDL cholesterol is effective in lowering heart disease risk. Some HDL treatments may even increase risk.

This study in 50 words or less

Researchers scoured the literature and found 31 high-quality studies conducted on various treatments designed to boost HDL. They found little evidence that any were effective. Those that may lower HDL have side effects or increased health risks.

Yes, but. . .

Like any study of other studies (a technique known as "meta-analysis"), this report lacks the power of a single, well-done study that focuses on a single outcome.

Some of the studies reviewed showed benefits of various HDL-boosting techniques--but the studies were small, not focused on this report's basic question, or otherwise inconclusive.

Data shows that high doses of the vitamin niacin can boost HDL cholesterol, but the report states that 1/3 of patients can't tolerate it. Treatment with niacin requires close medical supervision.

So what are you going to do about it?

The authors conclude that lower LDL cholesterol, which is proven to reduce heart disease risk, should remain the goal of treatment.

Next time you discuss cholesterol management with your physician or cardiologist, you may want to ask about the value of raising HDL compared to decreasing LDL for your specific case, given your unique risk profile and medical history.

The American Heart Association recommendations for HDL state that levels below 40 mg/dL for men or 50 mg/Dl for women are a "major risk factor for heart disease." Levels above 60 mg/dL are considered protective of heart disease. Again, you may want to discuss these figures with your doctor relative to your treatment.

If you get vigorous exercise, are not overweight, don't smoke, and eat a healthy diet (including some fish with omega-3 fats, like salmon) you can boost your HDL risk-free. These behaviors are linked with better cardiac and general health anyway.

Moderate alcohol consumption (less than one drink/day for women, 2/day for men) may also boost HDL. But experts do not recommend anybody who does not drink take up drinking alcohol for its heart benefits.

Learn more

Our site has some excellent questions and answers from Harvard Health Publications on HDL cholesterol.

Check out this overview of HDL medications, this one about the ability of high HDL to compensate for high LDL, and one about LDL/HDL ratios, a figure once used to help determine heart risk but which has since fallen out of favor in the cardiology community.

Craig Stoltz
Meet Our Writer
Craig Stoltz

Craig Stoltz is a health journalist who wrote for HealthCentral in 2007 and 2008.