Question: My HDL level is normally — between 26 and 30 — and my LDL levels are below 100. I have taken fish oil, lovastatin, and now take pravastatin and still can't get the level over 30. Niacin doesn't seem to help either. I am 59 years old, had heart bypass surgery several years ago, and take a low-dose aspirin daily. Any suggestions?
Dr. Hibberd’s answer:
You have low HDL — the "good” cholesterol — which is an independent risk factor for premature vascular disease and heart disease. Usually this is caused by genetics, but statin drugs will affect HDL cholesterol levels — with some decreasing and others increasing HDL.
Niacin will also improve HDL levels, which will lower your cardiac and stroke risk. In my experience, the newer generation statins such as Crestor and Lipitor have improved potency, are better tolerated by patients, and have less interaction with other drugs than the older statins. There are other agents available by prescription such as Zetia and fibrates that may be used to increase HDL, but the risks and benefits need to weighed by your prescribing physician.
Also, if you are a smoker, stop now. Smoking adversely affects your cholesterol significantly, and accelerates atherosclerosis and vascular disease, negating any progress you may make in raising your HDL.. Having had bypass surgery, your target for your LDL — the "bad" cholesterol — should be under 80. Omega-3 supplements (preferably a pure fish-based product such as prescription Lovaza) may improve your HDL (ideally you should aim to have an HDL of 60 or better), and is worth a try.
Do not forget that regular exercise and managing your weight will also reduce your health risks, as you seek to elevate your HDL.
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