High density lipoprotein, or HDL, cholesterol collects and transports excess fats from the blood to the liver for storage and disposal. Maintaining a healthy concentration of HDL is one of the hallmarks of health, and the National Institutes of Health advises men to target a ranges between 40 and 82 mg per deciliter while telling women to seek a higher level of 50 to 82 mg per deciliter. Some medications can interfere with reaching these goals and should be used with a consideration of their impact on cardiovascular health.
Beta Blockers
Beta-blockers are a class of medications used to treat high blood pressure, generalized anxiety disorder, heart failure, abnormal heart rate patterns and certain types of tremors. They include Coreg, Propranalol, Tenormin and Inderal. Each of these medications carries a warning regarding their effect on HDL in the Physician's Desk Reference except Coreg, which states only that it can "raise cholesterol." Coreg appears to lower HDL by raising blood glucose levels and hyperglycemia, or too much glucose in the blood is a known cause of low HDL.
Beta-blockers are recommended for the management of high blood pressure when weight loss and the use of diuretics, agents that increase the elimination of excess fluid in the body, have failed and the cholesterol profile, including the HDL level should be considered in making a decision about how to manage high blood pressure, according to the NIH Guidelines.
Anabolic Steroids
Anabolic steroids are synthetic versions of the male sex hormone, testosterone. They are used illegally for performance enhancement by some athletes and body builders and legally, in accord with the 2004 Anabolic Steroid Act, for the treatment of.severe and unexplained weight loss, the relief of pain in a small group of women with breast cancer, and after surgery for testicular cancer.
According to research by ML Sullivan, MD, MPH and CM Martinez, MD, anabolic steroids lower HDL by raising blood glucose levels and the level of triglycerides. Writing in the July-August 1998 issue of "Progressive Cardiovascular Disease" they noted that this lowering of HDL cholesterol is "temporary and reversible" although they also point out that the resultant accumulation of arteriosclerotic plaque in the arteries may be permanent if anabolic steroid use is prolonged.
Progestin
Menopause is a natural life stage, not a disease, but women who experience severe and frequent hot flashes, memory changes, depression or vaginal dryness often seek relief through the use of hormone replacement therapy or HRT as do women who want to lower their risk of osteoporosis.
Progesterone, a female hormone, is added to estrogen in HRT, to protect the woman from the increased risk of uterine cancer seen when estrogen is prescribed alone. Beginning in 2004, the American College of Obstetricians and Gynecologists bas recommended using HRT for the shortest possible time and at the lowest effective dose. The 2004 Guidance on HRT went on to say that HRT should not be used in an effort to prevent cardiovascular disease because any benefit seen with estrogen, which raises HDL is offset by the lowering of HDL that progesterone causes.
A 2009 study at Yale University College of Nursing found that the use of progesterone as the sole agent in birth control pills lowered HDL by 6mg per deciliter, pointing to another time when progesterone alone is a threat to cardiovascular health. (
References
- National Institutes of Health; ATP III Guidelines
- "Physicans Desk Reference"; PDR Network; 2010
- "Journal of Acquired Immune Deficiency Syndromes'; Hormonal Contraception and Metabolic Outcomes in Women With or at Risk for HIV Infection; Julie Womack, RN, PhD, CNM, et al; December 2009.
- "ACOG Web Site": ACOG 2004 Guidelines of the Use of HRT
- "Journal of Cardiovascular Diseases"; The cardiac toxicity of anabolic steroids.ML Sullivan, et al; July-August 1998
