HDL-The Good Cholesterol

Dr. Dave’s response to a question from a Facebook page member 

My husband’s HDL is 26. He’s almost 40 and has been trying to raise it for 9 years. He was told today it will not go up any more after pills and vitamins, etc. If he has not any other risk of health problems, just this super low HDL, what are his risks for a heart attack? His mother and her whole family all passed early (by 50-60) due to heart problems and he’s so worried now…

Thanks for asking this important question. Let’s bring everybody up to speed on HDL cholesterol.
HDL, the so-called ‘Good Cholesterol’, is an acronym for high-density lipoprotein. The reason it is GOOD is because HDL actually removes cholesterol from artery walls (and other places). Studies have shown the higher your HDL the lower is the incidence of coronary disease (plaque build up in heart arteries) and heart attacks (death of heart muscle due to artery blockages). Conversely, the lower the HDL the higher is the risk for coronary disease and heart attacks.

There are a number of causes of low HDL, including inherited genetic abnormalities, obesity and insulin resistance, diabetes, high triglycerides, anabolic steroids and certain medications. It seems most likely that your husband has an inherited disorder.

Here are the things that we know can increase HDL:

  1. Daily aerobic exercise (at least 30 minutes a day)
  2. Weight loss and tight control of diabetes, where applicable
  3. Nuts: raw almonds, pistachios, etc
  4. Smoking cessation, where applicable
  5. Niacin—prescription strength (often as high as 2000 mg dialy) is one of the primary medications used to treat isolated low HDL
  6. Fibrates—another class of medicines that can increase HDL in some patients.

If there’s room to work on any of these, I would not necessarily conclude that he’s out of devices to achieve a higher HDL.

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