Researchers at Johns Hopkins have issued guidelines for patients with low levels of good cholesterol or HDL in order to stay healthy with unclogged arteries. The article will be published in The New England Journal of Medicine online.
The researchers report that existing strategies to prevent heart disease have not addressed the best means to raise HDL cholesterol and instead have focused heavily on lowering LDL cholesterol, which leads to plaque formation and narrowing of the arteries that can cause heart attack.
According to them, existing guidelines from the U. S. National Institutes of Health and its National Cholesterol Education Program primarily emphasize lowering LDL cholesterol to control blood lipid levels without considering the alternative of raising HDL cholesterol as the primary or even secondary goal.
However, every single milligram per deciliter increase in HDL cholesterol lowers a person's risk of suffering a fatal heart attack by about 3 percent. Low levels of HDL cholesterol are known to increase overall risk of dying from heart disease and, specifically, to increase risk of arteries narrowing again after angioplasty surgery to clear them. Low levels of HDL cholesterol are defined as less than 40 milligrams per deciliter of blood in men and 50 milligrams per deciliter in women.
In the NEJM report, the researchers provide a comprehensive review and summary of the 50 most significant research studies on how best to manage peoples' HDL-cholesterol levels through modification of lifestyle risk factors for developing heart disease and use of drug therapy.
In addition, the researchers support their summary findings with a concise table listing heart medications with guidelines about how and when the drugs - niacin, fibrates and statins, or various combinations - can be used to raise HDL cholesterol levels. Also provided in the table are details on the drugs' chemical properties, or mechanism of action, and possible side effects.