Tanu Das

There are many reasons why some people have low HDL and others have high HDL. Genes appear to play the most important role by determining how much HDL cholesterol your body makes and the proportion of different subtypes. Lifestyle choices also affect HDL levels. Smoking, carrying too many pounds, and lack of physical activity tend to lower HDL. So does a diet high in refined carbohydrates (white bread, sugars, etc.). Medications such as beta blockers, anabolic steroids, progestin, and benzodiazepines can also depress HDL. A 55-year-old builder attends for a clinical review. He has a history of gout and hypertension which are both well controlled with ramipril 5 mg once daily and allopurinol 100 mg once daily. He has no history of cardiovascular disease, but both his mother and a maternal uncle developed type 2 diabetes mellitus in their late 60s. He is physically active with his job and enjoys watching his favourite football team play on weekends. He admits that he often drinks about 5 or 6 pints of beer when he watches a big game and will also drink about 10 cans of beer at home during the course of the week. He has gradually put on weight over the last decade and currently weighs 95 kg, BMI 30 kg/m². His blood pressure is 135/85 mmHg. You organise a series of investigations: total cholesterol 7.0 mmol/L, HDL cholesterol 0.7 mmol/L, triglycerides 2.4 mmol/L, fasting glucose 6.2 mmol/L, HbA1c 44 mmol/mol Hb. What is the most likely reason for his low HDL cholesterol? There are a number of conditions and lifestyle choices that play a role in lowering HDL levels. While these may not be a factor for you, think about these issues and discuss with your doctor:5 Excess weight: Having excess weight can cause a number of health conditions, including a decrease in your HDL levels. If you are overweight or obese, losing weight can increase these levels and lower your risk of heart disease. Genetic factors: Sometimes, very low HDL cholesterol levels can be inherited. Medical conditions that severely lower HDL levels include Tangier’s disease and familial hypoalphalipoproteinemia.6  Poor diet: What you eat can also influence your HDL levels. Limiting saturated fats (for example, butter, cream, whole or 2 percent milk, beef, pork, chicken with skin) and substituting them for monounsaturated fats like fatty fish, olives, and avocados can raise your HDL. Sedentary lifestyle: Adding moderate exercise to your daily routine may help increase your HDL levels slightly. The American Heart Association recommends aerobic exercising 40 minutes daily three to four times weekly—examples include swimming, brisk walking, running, bicycling, and dancing.7 Smoking: The chemicals found in cigarettes can lower your HDL cholesterol. Quitting smoking can help increase your HDL, as well as prevent other chronic diseases, including cardiovascular disease. Uncontrolled diabetes: Having high blood glucose levels may contribute to lowering HDL cholesterol levels. It can also increase triglyceride and LDL levels. Getting your blood sugar under control may help get your HDL levels back within a healthy range. This can be done by modifying your lifestyle or taking medication to treat it. What is the most appropriate approach to dealing with his low HDL cholesterol? Exercising more- Vigorous exercise is best for boosting HDL cholesterol, but any extra exercise is better than none. Losing weight- If you are overweight, losing 5% to 10% of your current weight can raise HDL cholesterol, along with reducing blood pressure and blood sugar. Cutting back on refined carbohydrates- Switching from refined carbohydrates to whole grains and adding more lean protein to your diet is a good dietary approach to increasing HDL. Stopping smoking- Quitting can improve HDL cholesterol and do so much more for your heart and health. Moderate alcohol intake- Drinking alcohol in moderation (no more than one drink a day for women, one to two for men) raises HDL. If you don't drink, there's no need to start — exercise, losing weight, and other lifestyle changes are plenty. Cholesterol does not travel freely through the bloodstream. Instead, it is attached or carried by lipoproteins (lipo = fat) in the blood. There are three types of lipoproteins that are categorized based upon how much protein there is in relation to the amount of cholesterol. Low-density lipoproteins (LDL) contain a higher ratio of cholesterol to protein and are thought of as the “bad” cholesterol. Elevated levels of LDL lipoprotein increase the risk of heart disease, stroke, and peripheral artery disease, by helping form cholesterol plaque along the inside of artery walls. Over time, as plaque buildup (plaque deposits) increases, the artery narrows (atherosclerosis) and blood flow decreases. If the plaque ruptures, it can cause a blood clot to form that prevents any blood flow. This clot is the cause of a heart attack or myocardial infarction if the clot occurs in one of the coronary arteries in the heart. High-density lipoproteins (HDL) are made up of a higher level of protein and a lower level of cholesterol. These tend to be thought of as “good” cholesterol. The higher the HDL to LDL ratio, the better it is for the individual because such ratios can potentially be protective against heart disease, stroke, and peripheral artery disease. Very low-density lipoproteins (VLDL) contain even less protein than LDL. VLDL like LDL has been associated with plaque deposits. Triglycerides (a type of fat) may increase cholesterol-containing plaques if levels of LDL are high and HDL is low. Total cholesterol score is the sum of HDL cholesterol, LDL cholesterol and 20% of triglycerides as determined by a blood test. A high score indicates an increased risk for developing cardiovascular disease and/or strokes. Reference: National Heart, Lung and Blood Institute (Accessed Oct. 5, 2018) what is cholesterol? Link- http://www.nhlbi.nih.gov/health/health-topics/topics/hbc American Heart Association (Accessed Oct. 5, 2018) Good vs. bad cholesterol Link- http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/Good-vs-Bad-Cholesterol_UCM_305561_Article.jsp#.V09AH9j2aic American Heart Association (Accessed Oct. 5, 2018) My cholesterol guide Link- http://www.heart.org/en/health-topics/consumer-healthcare/order-american-heart-association-educational-brochures Centers for Disease Control (Accessed Oct. 5, 2018) LDL and HDL: "Bad" and "good" cholesterol. Link- http://www.cdc.gov/cholesterol/ldl_hdl.htm Rosenson RS,( Accessed Oct. 5, 2018) HDL-cholesterol- Clinical aspects of abnormal values. Link- https://www.uptodate.com/contents/search Ballantyne CM (Accessed Oct. 5, 2018) Saunders Elsevier 2015.Therapeutic targeting of high-density lipoprotein metabolism. Link- http://www.clinicalkey.com Rader DJ.(Accessed: March15, 2012) Raising HDL in Clinical Practice- Clinical Strategies to Elevate HDL New York Link- http://Medscape: http://www.medscape.org/viewarticle/479499_5 HDL Cholesterol (Accessed Oct. 5, 2018) Lab Tests Online Link- https://labtestsonline.org/understanding/analytes/hdl/tab/sample