High density lipoprotein prevention

High Density Lipoprotein Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]; Raviteja Guddeti, M.B.B.S. [3]

Overview

Statins and fibrate appear to be effective in patients with low HDL levels compared to those in normal HDL levels in terms of risk reduction.Fibrates are more effective when low HDL levels coincide with low levels of LDL levels. Before a combination of statins and fibrates are considered, dietary modifications and lifestyle changes can be effective tools to raise HDL levels. However, a combination therapy of statins with fibrates can result in myopathy as a potential adverse effect.

Secondary Prevention

As of 2006, randomized clinical trials have demonstrated significant reduction of atherosclerosis progression and cardiovascular events with treatments that increase HDL-cholesterol (nicotinic acid or a fibrate). Pharmacological therapy to increase the level of HDL cholesterol includes use of fibrates and niacin. Consumption of niacin, an immediate release crystalline form of Vitamin B3, can increase HDL levels by 10–30%, and is the most powerful agent currently available to increase HDL-cholesterol. The use of statins is effective against high levels of LDL cholesterol, but it has little or no effect in raising HDL-cholesterol. The use of antioxidants in combination with statin and niacin therapy reduces the effectiveness of niacin by 33%. (NIH HATS).

Diet and Lifestyle

Certain changes in lifestyle can have a positive impact on raising HDL levels:

• Aerobic exercise
• Weight loss
• Smoking cessation
• Using supplements such as omega 3 fish oil
• Limiting intake of dietary fat to 30–35% of total calories
• Removing trans fatty acids from the diet
• Adding monounsaturated and polyunsaturated fats to the diet, and reducing or eliminating saturated fats.
• Drinking 1–2 servings of alcoholic beverages per day
• Adding soluble fiber to diet

Pharmacotherapy

CETP Inhibition

Anacetrapib

Anacetrapib raises HDL by 138%, and lowers LDL by 35% to 40%.

Evacetrapib

Evacetrapib raises HDL by 130% and lowers LDL by 35% to 40%.

Low HDL

Rule out secondary causes Hypothyroidism Diabetes mellitus Uremia Liver disease Medications - diuretics, progestin, androgens, beta blockers Acute illness - MI, burns, surgery

Lifestyle modification Diet Physical exercise Smoking cessation Weight loss Intake of unhydrogenated monounsaturated fat e.g., olive oil, canola oil

No Coronary heart disease

Assess risk

High risk CHD risk>20% per 10 years

Low risk CHD≤20% per 10 years

Statins or Niacin

Positive family history of premature CHD

Negative family history of premature CHD

Considar statins or niacin

Continue non-pharmacological approach

References

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