Increasing levels of high-density lipoproteins, better known as HDLor "good" cholesterol , reduced the risk for heart attack and stroke among patients with diabetes . That's according to a new study appearing online in The American Journal of Cardiology. The observational study, one of the largest of its kind, examinedthe medical records of more than 30,000 patients with diabetes andalso found that patients whose HDL levels decreased had more heartattacks and strokes. Researchers studied patients with diabetes because they are moreprone to heart disease with a lifetime risk as high as 87 percent, according to a paperfrom the landmark Framingham heart study published 2008. Whilethere is considerable evidence that reducing the amount oflow-density lipoprotein, also known as LDL or "bad" cholesterol,can reduce the risk of heart disease, the relationship between HDLcholesterol and heart disease is less clear. |
"Our study adds to the growing body of evidence that raising HDLlevels may be an important strategy for reducing heart attackrisk," said study lead author Gregory Nichols, PhD, seniorinvestigator with the Kaiser Permanente Center for Health Researchin Portland, Ore. "This is promising news for patients with diabetes, who alreadyhave an increased risk for heart problems. Raising their goodcholesterol may be one more way for these patients to reduce theirrisk," said Suma Vupputuri, PhD, co-author and investigator withthe Kaiser Permanente Center for Health Research in Atlanta. The study included 30,067 patients who entered Kaiser Permanentediabetes registries in Oregon, Washington and Georgia between 2001and 2006.
These patients had at least two HDL cholesterolmeasurements between 6 and 24 months apart. Most patients (61percent) had no significant change in HDL levels; in 22 percent ofpatients, HDL levels increased by at least 6.5 mg/dl (milligramsper deciliter of blood); in 17 percent of patients, HDL levelsdecreased by at least that same amount. After obtaining thecholesterol measurement, researchers followed the patients for upto 8 years to see if they were hospitalized for a heart attack orstroke. Patients whose HDL levels increased had 8 percent fewerheart attacks and strokes than patients whose HDL levels remainedthe same, while patients whose HDL levels decreased had 11 percentmore heart attacks and strokes. This study was observational sothere was no intervention to change HDL levels, and although manypatients were on statins to reduce their "bad" cholesterol, veryfew were on medications to improve HDL.
Past studies on this topic have reached contradictory conclusions.A study published in 2009 in the Archives of Internal Medicine found that for every 5 mg/dl improvement in HDL cholesterol levelpatients saw a 21 percent decrease in heart attack risk. But asystematic review of more than 100 clinical trials published in the British Medical Journa l in 2009 found that increasing HDL cholesterol did not reduce therisk of heart disease or death. Earlier this year the National Institutes of Health stopped aclinical trial using large doses of the B Vitamin niacin to boostHDL levels because the patients, who were already taking statins toreduce their "bad" cholesterol, saw no added reduction in heartattacks when they added niacin. Niacin is one of very fewmedications to increase HDL, but it can also have side effects suchas flushing, vomiting, dizziness and itching.
People can raise their HDL levels without medication by keepingtheir weight down, changing their diet, avoiding tobacco smoke, andincreasing exercise. Medical experts believe that HDL or "good"cholesterol carries the "bad" cholesterol away from the arteriesand back to the liver where it is processed and passed from thebody. According to the American Diabetes Association, a good targetfor women should be at least 50 mg/dl of HDL and for men at least40 mg/dl. Levels of 60 mg/dl or higher are thought to protectagainst heart disease. Additional References Citations.
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