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==Overview==
==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.
Prevention of low HDL may be achieved through lifestyle modifications such as [[physical exercise]], [[smoking cessation]], [[weight loss]],<ref name="Berns-1989">{{Cite journal  | last1 = Berns | first1 = MA. | last2 = de Vries | first2 = JH. | last3 = Katan | first3 = MB. | title = Increase in body fatness as a major determinant of changes in serum total cholesterol and high density lipoprotein cholesterol in young men over a 10-year period.|journal = Am J Epidemiol | volume = 130 | issue = 6 | pages = 1109-22 | month = Dec | year = 1989 | doi =  | PMID = 2589304 }}</ref> [[dieting]],<ref name="Wood-1988">{{Cite journal  | last1 = Wood|first1 = PD. | last2 = Stefanick | first2 = ML. | last3 = Dreon | first3 = DM. | last4 = Frey-Hewitt | first4 = B. | last5 = Garay | first5 = SC. | last6 = Williams | first6 = PT. | last7 = Superko | first7 = HR. | last8 = Fortmann | first8 = SP. | last9 = Albers | first9 = JJ. | title = Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. | journal = N Engl J Med | volume = 319 | issue = 18 | pages = 1173-9 | month = Nov | year = 1988 | doi = 10.1056/NEJM198811033191801 | PMID = 3173455 }}</ref>  and intake of unhydrogenated [[monounsaturated fat]].<ref name="Oh-2005">{{Cite journal  | last1 = Oh | first1 = K. | last2 = Hu | first2 = FB. | last3 = Manson | first3 = JE. | last4 = Stampfer | first4 = MJ. | last5 = Willett | first5 = WC. | title = Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study. | journal = Am J Epidemiol | volume = 161 | issue = 7 | pages = 672-9 | month = Apr | year = 2005 | doi = 10.1093/aje/kwi085 | PMID = 15781956 }}</ref><ref name="Mensink-1990">{{Cite journal  | last1 = Mensink | first1 = RP. | last2 = Katan | first2 = MB. | title = Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects. | journal = N Engl J Med | volume = 323| issue = 7 | pages = 439-45 | month = Aug | year = 1990 | doi = 10.1056/NEJM199008163230703 | PMID = 2374566 }}</ref>


==Secondary Prevention==
==Primary 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).<ref name="ehjs">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</ref> Pharmacological therapy to increase the level of HDL cholesterol includes use of [[fibrate]]s 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.<ref name="ehjs" /><ref name="rhcrcr">Raising HDL-Cholesterol and Reducing Cardiovascular Risk. Medscape Cardiology http://www.medscape.com/viewarticle/520393</ref>
Shown below is a table summarizing lifestyle modifications and their effect on HDL concentration.
<ref>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}}</ref>
The use of [[statins]] is effective against high levels of LDL cholesterol, but it has little or no effect in raising HDL-cholesterol. <ref name="rhcrcr" />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:<ref>{{cite web|author= Richard N. Fogoros, M.D.|url=http://heartdisease.about.com/cs/cholesterol/a/raiseHDL.htm|title=Raising Your HDL Levels}}</ref>
* [[Aerobic exercise]]<ref>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}}</ref>
* [[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 fat|trans]] fatty acids from the diet
* Adding [[monounsaturated fat|monounsaturated]] and [[polyunsaturated fat|polyunsaturated]] fats to the diet, and reducing or eliminating [[saturated fat]]s.
* Drinking 1–2 servings of [[alcoholic beverages]] per day
* Adding [[Dietary fiber|soluble fiber]] to diet


===Pharmacotherapy===
{| cellpadding=3 cellspacing=0 border=1 style="border-collapse:collapse"
====CETP Inhibition====
|bgcolor="#cccccc"| '''LIFESTYLE MEASURE'''
=====Anacetrapib=====
|bgcolor="#cccccc"| '''EFFECT ON HDL'''
[[Anacetrapib]] raises HDL by 138%, and lowers LDL by 35% to 40%.
|-
| [[Physical exercise]]<ref name="pmid2317921">{{cite journal|author=Thompson PD| title=What do muscles have to do with lipoproteins? | journal=Circulation |year= 1990 | volume= 81 | issue= 4 | pages= 1428-30|pmid=2317921 | doi= |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2317921}} </ref>
| 5-30% increase
|-
| [[Weight loss|Weight reduction]]
| 5-20% increase<ref name="pmid1386186">{{cite journal|author=Dattilo AM, Kris-Etherton PM| title=Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. | journal=Am J Clin Nutr |year= 1992| volume= 56 |issue= 2 | pages= 320-8 | pmid=1386186 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1386186  }} </ref>
|-
| [[Smoking cessation]]
| 5% increase<ref name="pmid21167347">{{cite journal| author=Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH|title=Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial. | journal=Am Heart J | year= 2011|volume= 161 | issue= 1 | pages= 145-51 |pmid=21167347 | doi=10.1016/j.ahj.2010.09.023 |pmc=PMC3110741|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21167347  }} </ref>
|-
| Multivitamins
| 31% increase in HDL
|-
| [[Dietary Approaches to Stop Hypertension|DASH diet]]
| 21% increase in HDL<ref name="Azadbakht-2005">{{Cite journal  | last1 = Azadbakht | first1 = L. | last2 = Mirmiran | first2 = P. | last3 = Esmaillzadeh |first3 = A. | last4 = Azizi | first4 = T. | last5 = Azizi | first5 = F. | title = Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. | journal = Diabetes Care | volume = 28 | issue = 12 | pages = 2823-31 | month = Dec | year = 2005 | doi =  | PMID = 16306540 }}</ref>
|-
| Low carbohydrate diet
| 4.5 mg/dl increase in HDL<ref name="Nordmann-2006">{{Cite journal  | last1 = Nordmann | first1 = AJ. | last2 = Nordmann | first2 = A. | last3 = Briel | first3 = M. | last4 = Keller | first4 = U. | last5 = Yancy | first5 = WS. | last6 = Brehm | first6 = BJ. | last7 = Bucher | first7 = HC. | title = Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. | journal = Arch Intern Med |volume = 166 | issue = 3 | pages = 285-93 | month = Feb | year = 2006 | doi = 10.1001/archinte.166.3.285 | PMID = 16476868 }}</ref>
|-
| Soy protein with isoflavones
| 3% increase in HDL<ref name="Zhan-2005">{{Cite journal  | last1 = Zhan | first1 = S. | last2 = Ho | first2 = SC. | title = Meta-analysis of the effects of soy protein containing isoflavones on the lipid profile. | journal = Am J Clin Nutr | volume = 81 | issue = 2 | pages = 397-408 | month = Feb | year = 2005 |doi =  | PMID = 15699227 }}</ref>
|-
| Fish oil (omega-3 fatty acid)
| Significant increase in HDL2 fraction<ref name="pmid7769501">{{cite journal| author=Sacks FM, Hebert P, Appel LJ, Borhani NO, Applegate WB, Cohen JD et al.|title=The effect of fish oil on blood pressure and high-density lipoprotein-cholesterol levels in phase I of the Trials of Hypertension Prevention. Trials of Hypertension Prevention Collaborative Research Group. | journal=J Hypertens Suppl | year= 1994 | volume= 12 | issue= 7 | pages= S23-31 | pmid=7769501 | doi= |pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7769501  }} </ref>
|-
| Fish oil with exercise
| 8% increase in HDL<ref name="pmid7653444">{{cite journal| author=Herrmann W, Biermann J, Kostner GM| title=Comparison of effects of N-3 to N-6 fatty acids on serum level of lipoprotein(a) in patients with coronary artery disease. | journal=Am J Cardiol | year= 1995 | volume= 76 | issue= 7 | pages= 459-62 |pmid=7653444 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7653444 }} </ref>
|-
| Low fat diet
|5-14% increase in HDL when combined with exercise<ref name="pmid16046704">{{cite journal| author=Varady KA, Jones PJ| title=Combination diet and exercise interventions for the treatment of dyslipidemia: an effective preliminary strategy to lower cholesterol levels? | journal=J Nutr | year= 2005 | volume= 135 |issue= 8 | pages= 1829-35 | pmid=16046704 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16046704  }} </ref>
|-


=====Evacetrapib=====
| Moderate [[alcohol]] consumption
[[Evacetrapib]] raises HDL by 130% and lowers LDL by 35% to 40%.
| 5-10% increase in HDL<ref name="Rimm-1999">{{Cite journal  | last1 = Rimm | first1 = EB. | last2 = Williams | first2 = P. | last3 = Fosher | first3 = K. | last4 = Criqui | first4 = M. | last5 = Stampfer | first5 = MJ. | title = Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors. | journal = BMJ | volume = 319 | issue = 7224 | pages = 1523-8 | month = Dec | year = 1999 | doi = | PMID = 10591709 }}</ref>
 
|}
 
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{{familytree | | | | | | | | | | | | | | | A01 | | | | | A01='''Low HDL'''}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | | | B02 | | | | | | B02=<u>Rule out secondary causes</u><br>[[Hypothyroidism]]<br>[[Diabetes mellitus]]<br>[[Uremia]]<br>[[Liver disease]]<br>Medications - [[diuretic]]s, [[progestin]], [[androgen]]s, [[beta blocker]]s<br>Acute illness - MI, burns, surgery}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | | | | | | C01 | | | | | | C01=<u>Lifestyle modification</u><br>[[Diet]]<ref name="Wood-1988">{{Cite journal  | last1 = Wood|first1 = PD. | last2 = Stefanick | first2 = ML. | last3 = Dreon | first3 = DM. | last4 = Frey-Hewitt | first4 = B. | last5 = Garay | first5 = SC. | last6 = Williams | first6 = PT. | last7 = Superko | first7 = HR. | last8 = Fortmann | first8 = SP. | last9 = Albers | first9 = JJ. | title = Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise. | journal = N Engl J Med | volume = 319 | issue = 18 | pages = 1173-9 | month = Nov | year = 1988 | doi = 10.1056/NEJM198811033191801 | PMID = 3173455 }}</ref><br>[[Physical exercise]]<br>[[Smoking cessation]]<br>[[Weight loss]]<ref name="Berns-1989">{{Cite journal  | last1 = Berns | first1 = MA. | last2 = de Vries | first2 = JH. | last3 = Katan | first3 = MB. | title = Increase in body fatness as a major determinant of changes in serum total cholesterol and high density lipoprotein cholesterol in young men over a 10-year period.|journal = Am J Epidemiol | volume = 130 | issue = 6 | pages = 1109-22 | month = Dec | year = 1989 | doi =  | PMID = 2589304 }}</ref><br>Intake of unhydrogenated [[monounsaturated fat]]<ref name="Oh-2005">{{Cite journal  | last1 = Oh | first1 = K. | last2 = Hu | first2 = FB. | last3 = Manson | first3 = JE. | last4 = Stampfer | first4 = MJ. | last5 = Willett | first5 = WC. | title = Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study. | journal = Am J Epidemiol | volume = 161 | issue = 7 | pages = 672-9 | month = Apr | year = 2005 | doi = 10.1093/aje/kwi085 | PMID = 15781956 }}</ref><ref name="Mensink-1990">{{Cite journal  | last1 = Mensink | first1 = RP. | last2 = Katan | first2 = MB. | title = Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects. | journal = N Engl J Med | volume = 323| issue = 7 | pages = 439-45 | month = Aug | year = 1990 | doi = 10.1056/NEJM199008163230703 | PMID = 2374566 }}</ref>
e.g., olive oil, canola oil}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | D02 | |D02='''No [[Coronary heart disease]]'''}}
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | E02 | |E02=Assess risk}}
{{familytree | | | | | | | | | | | | | |,|-|^|-|-|-|-|.| | | | | |}}
{{familytree | | | | | | | | | | | | | F03 | | | | | F04 | |F03=<u>'''High risk'''</u><br><br> CHD risk>20% per 10 years|F04=<u>'''Low risk'''</u><br><br>CHD≤20% per 10 years}}
{{familytree | | | | | | | | | | | | | |!| | | | | | |!| | | |}}
{{familytree | | | | | | | | | | | | | |!| | | | | | |!| | |}}
{{familytree | | | | | | | | | | | | | |!| | | | | | |!| | }}
{{familytree | | | | | | | | | | | | | H04 | | | | | |!| |H04=[[Statins]] or [[Niacin]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | |!| | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | | |,|-|-|-|^|-|-|-|.| | }}
{{familytree | | | | | | | | | | | | | | | | I05 | | | | | | I06 | |I05=Positive family history of premature CHD|I06=Negative family history of premature CHD}}
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | |!| | | |}}
{{familytree | | | | | | | | | | | | | | | | |!| | | | | | | |!| | | | | | | | | | | | |}}
{{familytree | | | | | | | | | | | | | | | | K04 | | | | | | K05 |K04=Considar [[statin]]s or [[niacin]]|K05=Continue non-pharmacological approach}}
{{familytree/end}}


==References==
==References==
Line 66: Line 57:
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Lipoproteins]]
[[Category:Lipoproteins]]
[[Category:HDLpedia]]


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Latest revision as of 16:03, 9 October 2014

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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

Prevention of low HDL may be achieved through lifestyle modifications such as physical exercise, smoking cessation, weight loss,[1] dieting,[2] and intake of unhydrogenated monounsaturated fat.[3][4]

Primary Prevention

Shown below is a table summarizing lifestyle modifications and their effect on HDL concentration.

LIFESTYLE MEASURE EFFECT ON HDL
Physical exercise[5] 5-30% increase
Weight reduction 5-20% increase[6]
Smoking cessation 5% increase[7]
Multivitamins 31% increase in HDL
DASH diet 21% increase in HDL[8]
Low carbohydrate diet 4.5 mg/dl increase in HDL[9]
Soy protein with isoflavones 3% increase in HDL[10]
Fish oil (omega-3 fatty acid) Significant increase in HDL2 fraction[11]
Fish oil with exercise 8% increase in HDL[12]
Low fat diet 5-14% increase in HDL when combined with exercise[13]
Moderate alcohol consumption 5-10% increase in HDL[14]

References

  1. ↑ Berns, MA.; de Vries, JH.; Katan, MB. (1989). "Increase in body fatness as a major determinant of changes in serum total cholesterol and high density lipoprotein cholesterol in young men over a 10-year period". Am J Epidemiol. 130 (6): 1109–22. PMID 2589304. Unknown parameter |month= ignored (help)
  2. ↑ Wood, PD.; Stefanick, ML.; Dreon, DM.; Frey-Hewitt, B.; Garay, SC.; Williams, PT.; Superko, HR.; Fortmann, SP.; Albers, JJ. (1988). "Changes in plasma lipids and lipoproteins in overweight men during weight loss through dieting as compared with exercise". N Engl J Med. 319 (18): 1173–9. doi:10.1056/NEJM198811033191801. PMID 3173455. Unknown parameter |month= ignored (help)
  3. ↑ Oh, K.; Hu, FB.; Manson, JE.; Stampfer, MJ.; Willett, WC. (2005). "Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the nurses' health study". Am J Epidemiol. 161 (7): 672–9. doi:10.1093/aje/kwi085. PMID 15781956. Unknown parameter |month= ignored (help)
  4. ↑ Mensink, RP.; Katan, MB. (1990). "Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects". N Engl J Med. 323 (7): 439–45. doi:10.1056/NEJM199008163230703. PMID 2374566. Unknown parameter |month= ignored (help)
  5. ↑ Thompson PD (1990). "What do muscles have to do with lipoproteins?". Circulation. 81 (4): 1428–30. PMID 2317921.
  6. ↑ Dattilo AM, Kris-Etherton PM (1992). "Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis". Am J Clin Nutr. 56 (2): 320–8. PMID 1386186.
  7. ↑ Gepner AD, Piper ME, Johnson HM, Fiore MC, Baker TB, Stein JH (2011). "Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial". Am Heart J. 161 (1): 145–51. doi:10.1016/j.ahj.2010.09.023. PMC 3110741. PMID 21167347.
  8. ↑ Azadbakht, L.; Mirmiran, P.; Esmaillzadeh, A.; Azizi, T.; Azizi, F. (2005). "Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome". Diabetes Care. 28 (12): 2823–31. PMID 16306540. Unknown parameter |month= ignored (help)
  9. ↑ Nordmann, AJ.; Nordmann, A.; Briel, M.; Keller, U.; Yancy, WS.; Brehm, BJ.; Bucher, HC. (2006). "Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials". Arch Intern Med. 166 (3): 285–93. doi:10.1001/archinte.166.3.285. PMID 16476868. Unknown parameter |month= ignored (help)
  10. ↑ Zhan, S.; Ho, SC. (2005). "Meta-analysis of the effects of soy protein containing isoflavones on the lipid profile". Am J Clin Nutr. 81 (2): 397–408. PMID 15699227. Unknown parameter |month= ignored (help)
  11. ↑ Sacks FM, Hebert P, Appel LJ, Borhani NO, Applegate WB, Cohen JD; et al. (1994). "The effect of fish oil on blood pressure and high-density lipoprotein-cholesterol levels in phase I of the Trials of Hypertension Prevention. Trials of Hypertension Prevention Collaborative Research Group". J Hypertens Suppl. 12 (7): S23–31. PMID 7769501.
  12. ↑ Herrmann W, Biermann J, Kostner GM (1995). "Comparison of effects of N-3 to N-6 fatty acids on serum level of lipoprotein(a) in patients with coronary artery disease". Am J Cardiol. 76 (7): 459–62. PMID 7653444.
  13. ↑ Varady KA, Jones PJ (2005). "Combination diet and exercise interventions for the treatment of dyslipidemia: an effective preliminary strategy to lower cholesterol levels?". J Nutr. 135 (8): 1829–35. PMID 16046704.
  14. ↑ Rimm, EB.; Williams, P.; Fosher, K.; Criqui, M.; Stampfer, MJ. (1999). "Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors". BMJ. 319 (7224): 1523–8. PMID 10591709. Unknown parameter |month= ignored (help)


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