Many population studies have shown that a low level of high density lipoprotein (HDL) cholesterol is a substantial risk for coronary heart disease. But it is difficult to raise your HDL cholesterol level because it is primarily determined by inherited genetic factors. A common definition of low HDL cholesterol is less than 40 mg/dL in men and less than 50 mg/dL in women.
The safest and simplest way to raise your HDL cholesterol is to make lifestyle modifications. Losing weight if needed, exercising more, and not smoking may increase your HDL cholesterol modestly. More effective measures are moderate alcohol intake and, in postmenopausal women, estrogen treatment. However, nondrinkers should not start to drink alcohol and long-term use of estrogen is associated with more frequent heart attacks despite a rise in HDL cholesterol.
Medications can certainly increase your HDL cholesterol. Most people with elevated low density lipoprotein (LDL) cholesterol should be taking a cholesterol-lowering statin, and those with elevated triglycerides are often prescribed a fibrate, like gemfibrizol or fenofibrate. Statins and fibrates each raise HDL cholesterol by about 10 percent. The most effective drugs to increase HDL cholesterol are the various preparations of niacin. These drugs, especially Niaspan, can raise your HDL cholesterol by 25 percent or more. Niaspan can often be added to a statin or fibrate if these drugs have not increased your HDL cholesterol enough.
The biggest quandary is what to do if your HDL cholesterol is too low while your LDL cholesterol and triglycerides are both normal -- often referred to as an isolated low HDL cholesterol. Some experts would recommend that you take Niaspan for an isolated low HDL cholesterol. I, among others, am not so sure about that approach for two reasons. Niaspan and other niacins can have significant side effects, including flushing, nausea and vomiting, liver problems, and an elevation of uric acid that can lead to attacks of gout. In addition, no studies have proven that raising HDL cholesterol levels reduces the risk of cardiovascular events.