Drugs Less Effective Than Lifestyle Modifications in Increasing HDL

Those with blood levels of HDL lower than 35 mg/dl (16-18% of men and 3- 6% of women) have eight times the risk of heart disease compared to those with 65 mg/dl or more. Thus, finding drug treatments to raise the level of HDL has become of major interest.

A team of investigators reviewed the literature related to attempts to raise HDL levels and compared results from lifestyle modification (dieting, exercise, etc.) to those from various drug treatments. Results of the review of 31 randomized controlled trials published in the August 15, 2007, issue of the Journal of the American Medical Association revealed that several lifestyle modifications were effective in increasing HDL. Among these lifestyle modifications were weight loss, exercise, smoking cessation, moderate alcohol consumption, and eating fish or taking fish oil to increase intake of omega-3 fatty acids.

As for pharmacologic approaches, the study found that the most effective currently available drug to raise HDL is the vitamin niacin, taken in high doses. "Statins, niacin, and fibrates are available pharmacological agents that increase HDL; however, they may be associated with adverse side effects,” said contributing author Dr. Mehdi Shishehbor from the Cleveland Clinic (OH, USA).

"Despite the recent negative HDL trials, this field is extremely exciting and the pace of discovery is unbelievably fast,” Dr. Shishehbor said. "At least one other drug with a novel mechanism of action is also in trials--and at least three other approaches have led to new drugs in the pipeline.”


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