Increasing HDL cholesterol could reduce cardiovascular risk in patients with coronary artery disease

In this study, researchers reviewed recent studies to determine which medications can reduce the risk of cardiovascular events (CVE), such as heart attack and stroke by improving the cholesterol profile.

Patients with coronary artery disease (CAD) often have high levels of low density lipoprotein or LDL (also known as the “bad” cholesterol) and triglycerides or TG (the main form of fat in the body) and low levels of high density lipoprotein or HDL (also known as the “good” cholesterol). High levels of LDL and TG in the blood build up on the inner surface of the arteries, thereby impairing blood flow and hardening the arteries, which in time leads to high blood pressure and an increased risk of CVE such as heart attack or stroke. HDL cholesterol is a type of fat that helps remove bad cholesterol from the blood by transporting it to the liver where it can be reprocessed. High HDL levels are thought to reduce CVE risks. Because high LDL is especially linked to CVE, reducing it is usually a top priority. Statin drugs can help lower LDL levels, but HDL levels can still remain low and TG levels can remain high. Low HDL and high TG are also linked to CVE, so finding ways to elevate HDL and reduce TG are important for CAD patients’ health.

This review summarized the effects of the 4 main classes of medications that work on LDL, HDL, and TG profiles and their effects on CVE risk. These drugs include statins, fibric acid derivatives, niacin, and cholesteryl ester transfer protein (CETP) inhibitors. Statins, such as atorvastatin (Lipitor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and others reduce LDL and modestly increase HDL. Fibric acid derivatives, such as fenofibrate (Tricor), mainly help reduce TG levels and they can slightly raise HDL. Drugs like fenofibrate could be useful for CAD patients, if combined with statins. Niacin (Niaspan) is a common medication that increases HDL levels and can reduce CVE. Combined with statins, niacin could be helpful for many CAD patients. However, niacin can have adverse effects on glucose regulation, so diabetic patients might not tolerate it. Finally, CETP inhibitors are a class of drugs that work by blocking a protein that normally transfers cholesterol from HDL to form LDL, therefore they might reduce LDL and increase HDL levels. However, variation in results between different trials carried out so far means that more research is needed before these drugs are used for the general public.

In summary, several classes of medications, notably fibric acid derivatives and niacin, can reduce CVE and could be especially useful when combined with statins.

Talk to your doctor about improving your HDL levels by combining other medications with statins.