Patients at risk of heart disease are generally concerned with keeping cholesterol and lipids at lower levels. However, high-density lipoproteins, or HDL, is often known as "good" cholesterol and higher levels of HDL have been shown to be associated with lower risk of cardiovascular disease. Many medications used to lower low-density lipoproteins, or LDL, or "bad" cholesterol, will also help to increase HDL.
Cholesterol and Heart Disease
An increase in triglycerides and total cholesterol could indicate that patients also have larger amounts of LDL circulating in the bloodstream. LDL cholesterol can accumulate on the inner linings of arteries, especially if the inner lining has been damaged by high blood pressure. In a complex process that includes platelet aggregation, a clot may be formed. As a result, blood flow is restricted from the narrowing of arteries. In addition, the clot could dislodge and occlude smaller vessels, causing a stroke or heart attack.
High-Density Lipoproteins
Researchers believe that the function of high-density lipoproteins, or HDL, in the bloodstream is to pick up and transport excess cholesterol from the blood back to the liver for elimination. HDL may also remove cholesterol from arterial plaques that may have already formed. Higher levels of HDL may indicate that cholesterol is effectively being removed from the blood back to the liver.
HDL Goals
According to the American Heart Association and Mayo Clinic web site, men are at higher risk of heart disease when HDL is less than 40 mg/dL. Women are at increased risk when HDL drops below 50 mg/dL. The optimal level of HDL in both groups is greater than 60 mg/dL. Many patients are required to take medications to increase HDL levels and reduce the risk of cardiovascular disease.
Cholesterol Lowering Medications
Medications in the drug class known as statins have been shown to decrease LDL cholesterol and moderately increase HDL cholesterol. Statins decrease the production of cholesterol in the liver which may promote the removal of cholesterol from the blood stream. Fibrates including fenofibrate and gemfibrozil that are effective at lowering triglycerides can also increase HDL levels. However, niacin has been shown to have the most impact on increasing HDL levels, especially when combined with other cholesterol-lowering medications.
Niacin
Niacin has been shown to increase HDL even in normal patients who do not have hyperlipidemia. Unfortunately, higher doses of niacin that are usually required to produce the increased HDL effect, also may lead to unwanted side effects. Patients using niacin to increase HDL should obtain approval from a physician, since monitoring of adverse effects may be required. The most common complaint of niacin therapy is flushing in the face and chest area. This side effect can be reduced by using time-release products or taking a non-coated aspirin before the niacin. Although available over-the-counter, patients should speak to their physician about prescription niacin as an option to increase HDL.
