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Cholesterol Revelations Spur New Treatments

Armen Hareyan's picture


Having too little "good" cholesterol may trigger a higher frequency of heart disease than having too much of the "bad" variety, according to research at Baylor College of Medicine.

Dr. Christie Ballantyne, a professor of medicine at BCM, says that patients with cholesterol problems should pay closer attention to raising their high-density lipoprotein (HDL) levels, the so-called "good" cholesterol that removes the "bad" kind (low-density lipoproteins (LDL) from arteries. A low HDL level is the most common cholesterol problem found in people with heart disease.

"The public was first educated on total cholesterol, and then the shift was on LDL cholesterol and keeping that level down," said Ballantyne. "HDL cholesterol is at least as important as LDL cholesterol and may even be more predictive of heart disease."

The complex genetics of HDL make it more difficult to analyze than the relatively straightforward LDL. As a result, treatments for the two kinds of cholesterol vary in efficacy.

"I can fairly routinely lower a patient's LDL by more than 50 percent," said Ballantyne. "I cannot raise their HDL by the same amount."

Several national and international studies are currently exploring potential treatment methods to increase HDL levels. One involves administering high doses of niacin, a vitamin known to raise HDL, while another focuses on creating synthetic HDL. A third approach centers on targeting adipose tissue, a specialized connective tissue that stores fat in the form of artery-clogging triglycerides, and a fourth approach inhibits an enzyme to raise the level of HDL.

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A comprehensive solution to cholesterol problems could take the form of a pill that combines both an HDL booster such as niacin and an LDL inhibitor such as statins. The combination could be cheaper and would likely improve compliance among patients who are reluctant to take several kinds of medication, said Ballantyne.

"The goal is to develop more effective drugs and combine highly effective drugs into one pill," said Ballantyne. "It would make it easier for people to control their problems long-term."

Ballantyne says an HDL level of at least 60 is ideal. Men with HDL readings of less than 40 and women with less than 50 should seek treatment.

If history is any indication, people with poor HDL levels should be optimistic about ongoing research. Ballantyne points out that less than 20 years ago, physicians had difficulty lowering LDL levels by 25 percent whereas now a 50 percent reduction is considered routine.

"What we hope is that we can see that kind of tremendous improvement in HDL," said Ballantyne. "And it may take a short period of time."

Prospective study participants with low HDL or other cholesterol problems can call 713-798-3171.

HOUSTON - (June 29, 2005)