High density lipoprotein prevention
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High Density Lipoprotein Microchapters |
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Diagnosis |
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Treatment |
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Clinical Trials |
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Case Studies |
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High density lipoprotein prevention On the Web |
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American Roentgen Ray Society Images of High density lipoprotein prevention |
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Risk calculators and risk factors for High density lipoprotein prevention |
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).[1] 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.[1][2] [3] The use of statins is effective against high levels of LDL cholesterol, but it has little or no effect in raising HDL-cholesterol. [2]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:[4]
- Aerobic exercise[5]
- 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 e.g., 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
- ↑ 1.0 1.1 Reducing risk by raising HDL-cholesterol: the evidence. # European Heart Journal Supplements Vol 8 Suppl F p. F23-F29 http://eurheartjsupp.oxfordjournals.org/cgi/content/abstract/8/suppl_F/F23
- ↑ 2.0 2.1 Raising HDL-Cholesterol and Reducing Cardiovascular Risk. Medscape Cardiology http://www.medscape.com/viewarticle/520393
- ↑ Chapman M, Assmann G, Fruchart J, Shepherd J, Sirtori C. Raising high-density lipoprotein cholesterol with reduction of cardiovascular risk: the role of nicotinic acid - a position paper developed by the European Consensus Panel on HDL-C. Cur Med Res Opin. 2004 Aug;20(8):1253-68. PMID 15324528
- ↑ Richard N. Fogoros, M.D. "Raising Your HDL Levels".
- ↑ Spate-Douglas, T., Keyser, R. E. Exercise intensity: its effect on the high-density lipoprotein profile. Arch Phys Med Rehabil 80, 691-695. PMID 10378497