DEAR DOCTOR K:
I have high levels of HDL cholesterol — the “good” cholesterol. I was happy about that, but now I hear that medicines raising your HDL levels don’t seem to help. Should I be disappointed?
The HDL cholesterol story is complicated. It has been solidly established that people who have high levels of LDL (bad) cholesterol have a higher risk of developing heart disease. Moreover, it has been solidly established that treatments that lower LDL cholesterol reduce the risk of developing heart disease.
It also has been solidly established that people with HDL levels above 60 milligrams per deciliter (mg/dL) tend to have a lower risk for heart disease. Since HDL removes cholesterol from the plaques in arteries, that observation made sense. So doctors and scientists developed drugs that raise HDL levels, just as they had developed drugs that lower LDL levels.
Several drugs that raise HDL levels have been around for 30 years, particularly gemfibrozil and niacin. But they raise levels only modestly. These drugs were tested in people with heart disease. They did lower the risk of new heart problems. However, it wasn’t clear if they achieved that benefit by raising HDL or through some other effect.
In the past several years, several different types of drugs were developed that could dramatically raise HDL levels. Most doctors, myself included, bet that such drugs would probably reduce the risk of heart disease. Why? Because all the evidence seemed to point in that direction.
Before such drugs were approved by the Food and Drug Administration, however, the agency required that studies involving large numbers of people be conducted to prove the value of the drugs. To make a long and painful story short, these drugs have not convincingly lowered the risk of heart trouble. Worse, in some cases, they have increased the risk.
To make things more confusing, a Harvard study found that people with an unusual genetic condition that raises HDL levels did not have fewer heart attacks. The most likely conclusion of this surprising result is that it is not the high HDL levels, but rather something else about most people who have high HDL levels that protects them from heart disease.
Many lifestyle changes raise HDL cholesterol and indisputably reduce your risk of heart disease: regular exercise, healthy weight, avoiding trans fats, quitting smoking and moderate use of alcohol. These lifestyle changes may not work through their effects on your HDL level, but they surely and powerfully do work.
So you should still be happy about your high HDL level. In most people, it means that they do have a lower risk of heart disease.
And I haven’t given up hope that some new HDL-raising drug may produce heart benefits. Or even that one of the new drugs already developed, but used in a different dose, may prove beneficial. Until that day comes, you can raise your HDL even higher with the lifestyle changes I mentioned — and definitely improve your overall health as well.