Usually patients with lipid profiles too high in LDL, the low-density "bad" cholesterol, and too low in HDL, the high-density "good" type, have been prescribed drugs that increase the amount of HDL cholesterol produced in the body with the goal of taking advantage of the protective effects of this waxy, fatty molecule. However, a recent study by Cambridge University's School of Clinical Medicine published in Science Magazine targeting the genetic component to this puzzle may make you look more critically at this choice.
Heart disease risk comparable to smoking
We normally want to increase the amount of HDL while keeping LDL lower in proportion. In theory, this has a protective effect on the heart and arteries, healing the endothelium and keeping away hardening plaques. It seems that an increase of HDL without addressing the other components of a patient's health portfolio increases the risk of heart disease and heart attacks up to 80%, comparable with the risk involved in smoking.
This study began by investigating individuals who have naturally high HDL, as determined by the SCARB1 gene mutation. The logical deduction in this scenario is that this study group would have a significantly decreased risk of heart disease, but this was not shown to be the case.
The SCARB1 mutation creates a perfect storm when it comes to cholesterol regulation inside the body. Not only does it increase the amount of available, circulating HDL, but it also destroys the ability of the HDL receptor sites to appropriately take up and utilize this essential particle. This leads to more cholesterol than the liver can process and eliminate, and a buildup of plaques and blockages in the major arteries around the heart.
The problem with HDL drugs taken in isolation
Many cardiologists are not surprised by these results. They have seen a lack of improvement in the majority of patients who are taking drugs designed to raise HDL in isolation from other variables, and they have observed the life-threatening events that follow instead. While readers may be tempted to think that this means there is no such thing as "good" cholesterol, the truth is that these are necessary substances, and a measurement of a single factor apart from the whole picture of a patient's health is incomplete. A severely narrowed focus on variables such as this can have dangerous consequences for a patient's health.
It turns out that it isn’t just the proportion of HDL to LDL that matters, but also the quantity of both that are produced, and also how a patient reaches those levels. It's becoming increasingly clear that drugs, or at least drugs alone, do not seem to be the final answer on this issue.
Healthy lifestyle factors can effect HDL and LDL
The best and most reliable ways to both raise a patient's HDL and lower LDL are healthy lifestyle factors, such as quitting smoking, exercising more, and drinking alcohol in moderation. Stress can play a major role in disturbing this proportion, so patients should actively seek ways to decrease this. Dietary choices should focus on decreasing refined carbohydrates and eliminating trans-fats, while increasing foods like fish, avocados, and olive oil.
These lifestyle changes play a pivotal part in maintaining good heart health, but if they aren't enough, prescriptions such as a fibrate or slow release niacin can be considered, and have shown to be excellent adjuncts for those fighting heart disease.
The bottom line is that isolating a single factor isn’t going to help the patient achieve the health results that we’re all ultimately looking for. Taking a well-rounded approach that incorporates all measurable risk factors, lifestyle choices, dietary options, and prescription effects will have the best outcome for your patients.