HDL is well known as good cholesterol, and that LDL is the bad cholesterol. Therefore, to lessen the chance of a heart attack, the HDL should increase, and the LDL should decrease.
The easy way to increase the HDL is to take medicines like nicotinic acid (a.k.a. niacin) and fibrates. Both medications can increase the value of HDL. But can niacin and fibrate drugs make the patients who take them to avoid dying from cardiovascular disease?
That was the purpose of the meta-analysis entitled Effect of HDL-Raising Drugs on Cardiovascular Outcomes that was published in 2014. It put together 12 studies and analyzed the outcome in 26,858 patients. Half of whom took either the niacin or fibrates or the CTEP-inhibitors. The other half did not take anything to increase their HDL.
The result showed that even though their HDL numbers increased, the mortality rate of the study group from all causes, including cardiovascular diseases, is the same compared to the control group.
The AIM-HIGH Study
The Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health Outcomes (AIM-HIGH) study was done to see if there is a benefit in adding niacin to statins. The study was stopped after 3 years as it failed to show any clinical advantage in adding niacin to the overall cardiovascular mortality. Even though the combination of niacin and statins increased the HDL and lowered the triglyceride levels significantly.
Niacin also leads to high levels of uric acid and insulin resistance and should be used very carefully in patients with gout and diabetes mellitus. Niacin use has dropped significantly.
The HPS2-THRIVE and dal-OUTCOMES
The Heart Protection Study 2–Treatment of HDL to Reduce the Incidence of Vascular Events a.k.a. HPS2-THRIVE studied used the niacin-laropiprant combination.
dal-OUTCOMES stands for The Effects of the Cholesterol Ester Transfer Protein Inhibitor Dalcetrapib in Patients with Recent Acute Coronary Syndrome. This study was designed to determine whether the CETP inhibitor dalcetrapib reduces cardiovascular mortality or morbidity in patients with stable coronary heart disease patients.
Both studies, HPS2-THRIVE and dal-OUTCOMES, also showed that increasing the numerical value of the HDL does not translate into improving the mortality rate.
What About the Statins?
The statins were not included in the study because the statins can both lower the LDL and increase the HDL at the same time. That is why it will be challenging to know where to assign the benefit of improved survival in case there is.
Other Ways to Increase Your HDL
- Exercise
- Quit smoking
- Avoid Tans fats in the diet
- Eat plenty of vegetables, legumes
- Omega-3 fatty acids from fish, chia seeds, and walnuts.
- Lose weight if overweight or obese
The message of this piece rhymes with the previous articles on this website like The Five Whys, Why Do You Need an Excellent Performance Status?, Understanding Heart Failure Treatment and Strategies to Prevent Dialysis.
Medicines are prescribed only to help the body eliminate the disease. Medications cannot treat by themselves.
Don’t Get Sick!
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Related Readings:
- The Deadliest Diseases Associated with Metabolic Syndrome
- Atrial Fibrillation and Metabolic Syndrome
- How Effective are Drugs that Increase HDL?
- Can You Be in Heart Failure Now?
- What Starts Atherosclerosis?
- The Magical Endothelium
- How Does Diabetes Destroy Arteries
- How Diabetes Destroys the Body
- Understanding Heart Failure Treatment
- Coronary Stents and Blood Thinners
- How Effective is Quitting Cigarettes?
- Hair Loss and Heart Attacks
- The Real Effect of Statins on Heart Disease
- LDL: “Bad Cholesterol” is Not All Bad.
Reference
- Kaur et al., Effect of HDL-Raising Drugs on Cardiovascular Outcomes: A Systematic Review and Meta-Regression. Plos One. April 11, 2014. https://doi.org/10.1371/journal.pone.0094585
- AIM-HIGH Investigators, Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, Koprowicz K, McBride R, Teo K, Weintraub W. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2012;365(24):2255–2267. [PubMed]
- Hassan, Mohamed. “HPS2-THRIVE, AIM-HIGH, and dal-OUTCOMES: HDL-cholesterol under attack.” Global cardiology science & practice vol. 2014,3 235-40. 16 Oct. 2014, doi:10.5339/gcsp.2014.37
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