~ Johns Hopkins Authors Issue Guidelines for Raising HDL

An article by Johns Hopkins cardiologist Roger Blumenthal, MD, and nurse practitioner Dominique Ashen, PhD, CRNP, published in the September 22 2005 issue of the New England Journal of Medicine offers guidelines on how to raise high-density lipoprotein, or HDL cholesterol the "good" form of cholesterol that is protective against atherosclerosis.

Most guidelines for cardiovascular disease prevention have strongly focused on lowering low-density lipoprotein, or LDL cholesterol, which is associated with arterial plaque formation when elevated. It is estimated that over 54 million people in the United States have less than desirable HDL levels (less than 40 milligrams per deciliter of blood for men and 50 milligrams per deciliter for women).

Dr Blumenthal, who is director of the Ciccarone Preventive Cardiology Center at The Johns Hopkins University School of Medicine, explained that current guidelines from the U.S. National Institutes of Health emphasize LDL reduction but fail to consider the alternative of raising HDL as the primary or secondary goal, even though each milligram per deciliter increase in HDL reduces the chances of dying from a heart attack risk 3 percent. He announced, "We have reached a turning point in the prevention of coronary heart disease from an emphasis during the last 15 years on lowering LDL cholesterol levels to an emphasis in the next decade on raising levels of HDL cholesterol."

Following a review of the 50 most significant articles evaluating methods to raise HDL, the authors recommend such lifestyle modifications as regular exercise, smoking cessation, weight control, mild to moderate alcohol intake (for those without liver dysfunction or a history of alcoholism), and diets rich in omega-3 fatty acids with reduced high glycemic carbohydrates.

Of therapeutic agents that can be administered to raise HDL levels, the B vitamin niacin offers the greatest benefits, with HDL increases of 20 to 35 percent associated with its use. While fibrate drugs produce a 10 to 25 percent increase, statin drugs are the least effective, as they have only shown an ability to raise HDL by 2 to 15 percent. However, when statins are combined with niacin, their effectiveness is boosted.

Dr Ashen, who is the lead author of the report, summarized, "The guidelines should help physicians and nurses to manage their patients' blood lipid levels, including HDL cholesterol, with drug therapies currently available, and should help prepare them to manage future therapies, expected to be developed within the next five years, that focus on raising HDL-cholesterol levels."

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