Tips for you

Greater Kashmir

Increase Good (HDL) Cholesterol and live longer, Dr. Upendra Kaul  has got some important tips for you to stay fit.


 It is an epidemiologically proven fact that low levels of HDL cholesterol (<40mg/dl in men and <50mg/dl in women) are associated with increased risk of coronary heart disease (leading to heart attacks, angina, sudden death) recurrence after angioplasty, bypass surgery, etc. The problem is further increased if the person has in addition high blood pressure, diabetes and or high level of serum triglycerides (ugly cholesterol).
 Increasing HDL cholesterol level is of great utility in reducing this increased risk. In humans each increase of 1mg/dl is associated with a 6% decrease in risk of death from coronary disease or heart attack. This is much more than the benefit accrued by reducing 1mg of LDL cholesterol (bad cholesterol) which reduces this risk by only 2%.
 Low HDL cholesterol level is a major problem in South Asian population with at least 30% of our population having low levels. This is considered to be a part of cardio metabolic syndrome which makes our population prone to acquire more ischemic heart disease with extensive blocks at a young age.


RECOMMENDED MEASURES:


Life Style Modification Based


A. EXERCISE
 A regular program of brisk aerobic exercise for 30 minutes on most days of the week is an accepted recommendation.
 The benefit is more often seen in people with associated high triglyceride levels and abdominal obesity, than in those with isolated low HDL cholesterol. Regular low intensity exercise is better than sporadic high intensity exercise in this regard.
 The benefit however is modest with the maximum reported increase of 6 to 9%.


B. WEIGHT CONTROL
 Overweight is associated with reduced HDL cholesterol. A stabilized weight reduction maintained beyond 6 weeks is associated with a 3 – 4% increase in HDL cholesterol levels.
 A weight reducing plan of 1 Kg per week with a target body mass index (weight in kg /square of height in meters) of less than 25 should be the target.


Dietary Fat Intake
 A diet rich in omega-3 polyunsaturated fatty acids increases HDL cholesterol levels. This has been observed in Native Alaskan population. Sources rich in omega 3 fatty acids are;
Oils; – olive, mustard, canola, soya etc;
Nuts –almond, peanuts, walnuts,
Fish – salmon (trout), shell fish, mackerel (sea fish)
 This combined with limited intake of carbohydrates which promptly increases blood sugar level (potatoes, white bread, snack foods, ready to eat cereal) are recommended to increase blood levels of HDL-cholesterol.
 A concomitant decrease in bad cholesterol (LDL-cholesterol) is recommended by reducing intake of dietary saturated fatty acids (milk products, red meat, egg yolk, etc.).


Smoking Cessation:
 Cigarette smokers have lower levels of HDL-cholesterol. Stopping smoking can potentially increase HDL – cholesterol by a mean of 4 mg per deciliter. This phenomenon is seen more often in women.


Role of Drugs to Increase HDL Cholesterol Level   
 Several classes of drugs increase HDL cholesterol levels. These include Niacin (nicotinic acid or vitamin B3) which can increase it by 25 –30%; fibrates (gemfibrozil, fenofibrate and bezafibrate) and statins (simvastatin, atorvastatin and rosuvastatin, etc).
 These drugs always recommended under strict medical supervision also reduce triglyceride and LDL cholesterol levels significantly. At present there is no consensus regarding when to use these medicines for the purpose of increasing HDL cholesterol. These drugs are most often used in patients with very high risk or those with established coronary disease.


Futuristic Therapies
 Bioengineered molecular such as recombinant apolipoprotein A 1 – Milano, mimics the properties of nascent – HDL – cholesterol. Pilot studies conduced in small number of human subjects have shown modest but significant reduction in plaques (fat deposits) and measurements of markers of atherosclerosis by intravascular ultrasound.
 A new drug (partial inhibitor of CETP activity) torcetrapib has been reported to increase HDL cholesterol by a mean of 32 mg/dl. The drug in combination with a statin (atorvastatin) has not proven to be beneficial. On the other hand this drug probably because of increasing blood pressure has been reported to increase heart attacks. This was a disappointing news.
 Search is on for new drugs to increase HDL cholesterol which would have clinical benefit in the long term. A number of such agents are underway.


Conclusion
 Life style changes are recommended as the first approach to increase HDL cholesterol at present. These measures should lead to cardiovascular benefits and reduction in events like heart attacks and its complications. A regular programmed of 30 – 40 minutes of brisk aerobic activity, keeping the body mass index to less than 25, consumption of oils such as olive, mustard, canola, soya, nuts, cold water fish with high content of omega 3 fatty acids is of proven benefit.
 Addition of drugs has to be individualized in high risk subjects under strict medical supervision.  
         
(Dr. Upendra Kaul  is Executive Director Cardiology, Fortis Hospitals, New Delhi and NOIDA)