Ask Doctor K: High HDL small part of healthy heart

DEAR DOCTOR K: I have high levels of HDL cholesterol – the “good” cholesterol. I was happy about that, but now I hear that medicines raising your HDL levels don’t seem to help. Should I be disappointed?

DEAR READER: The HDL cholesterol story is complicated. It has been established that people who have high levels of LDL (bad) cholesterol have a higher risk of developing heart disease. Moreover, it has been established that treatments that lower LDL cholesterol reduce the risk of heart disease.

It also has been solidly established that people with HDL levels above 60 milligrams per deciliter tend to have a lower risk for heart disease. Since HDL removes cholesterol from the plaques in arteries, that observation made sense.

Several drugs that raise HDL have been around for 30 years. These drugs were tested in people with heart disease. They did lower the risk of new problems, yet it wasn’t clear if they achieved that by raising HDL or by some other effect.

In past years, several different types of drugs were developed that could dramatically raise HDL levels. Most doctors, myself included, bet that such drugs would probably reduce the risk of heart disease. Why? Because all the evidence seemed to point in that direction.

Before such drugs were approved by the Food and Drug Administration, however, the agency required studies involving large numbers of people be conducted to prove the value of the drugs. To make a long and painful story short, these drugs have not convincingly lowered the risk of heart trouble. Worse, in some cases, they have increased the risk.

Many lifestyle changes raise HDL cholesterol and indisputably reduce your risk of heart disease: regular exercise, healthy weight, avoiding trans fats, quitting smoking and moderate use of alcohol. These lifestyle changes may not work through their effects on your HDL level, but they surely and powerfully do work.

So you should still be happy about your high HDL level. I haven’t given up hope that some new HDL-raising drug may produce heart benefits.