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New review suggests caution on drugs to raise 'good' cholesterol
Date:8/14/2007

not have a simple way to tell this bad type of good cholesterol from the genuinely beneficial kind in their patients. Right now, only expensive tests used in research settings can sort this out.

Fortunately, lifestyle changes can help without negative side effects, according to the review. The safest way to raise HDL is by weight loss, exercise and smoking cessation, Shishehbor said.

The review also found support for moderate alcohol use one or two drinks a day for men, one for women although physicians do not recommend that nondrinkers take up drinking to protect their hearts. Raising HDL by eating fish or taking fish oil to increase intake of omega-3 fatty acids is another effective strategy, the review suggested.

As for pharmacological approaches, the review found that the most effective currently available drug to raise HDL is the vitamin niacin, taken in high doses. Statins, niacin and fibrates are available pharmacologic agents that increase HDL; however, they may be associated with adverse side effects, said Shishehbor, who recommended close medical supervision.

At least one-third of patients cannot tolerate high-dose niacin, according to Shah. The most common side effect is flushing and itching that drives some people nuts. He said methods exist to minimize the problem, but they do not work for everyone.

Meanwhile, new medications have proved disappointing. Trials of one drug, torcetrapib, ended abruptly because the drug increased mortality risk and raised blood pressure. The class of diabetes drugs called thiazolidinediones (which include Avandia and Actos) increase HDL, but also seem to raise the risk of cardiovascular problems.

The once highly touted weight-loss drug rimonabant, which blocks the brain receptors activated by marijuana, does raise HDL; however, the U.S. Food and Drug Administration recently refused to approve it because it also seems to elevate risk for psychiatric problems like d
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Contact: Lisa Esposito
hbns-editor@cfah.org
Center for the Advancement of Health
Source:Eurekalert

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