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Reader Response: Cholesterol Levels

What can I do to raise my HDL and lower trigs?

A HeartMail reader recently wrote, asking how he could raise his HDL (good cholesterol) levels and lower his triglycerides.

Cholesterol plaque in an artery. A great question, since cholesterol and triglyceride levels are among the major controllable risk factors for coronary heart disease, heart attack and stroke, according the American Heart Association.

We posed the question to Peter Oettgen, MD, Director of Preventive Cardiology at BIDMC. First, he reviewed the basics.

What Are Trigs and HDL?

Triglycerides and cholesterol are separate types of "fat" or lipids found in the blood. Triglycerides and cholesterol circulate throughout the body with the help of lipoproteins (proteins that transport lipids).

Triglycerides are either made in the liver or ingested from food. They provide the body with energy to function, but any excess triglycerides in the body are stored as fat.

Cholesterol is used to build cells and create hormones. Cholesterol can also be found in foods such as meat, egg yolks, poultry and high-fat milk products or processed foods. LDL is low-density lipoprotein or "bad" cholesterol. HDL is high-density lipoprotein cholesterol or "good" cholesterol.

The Good, the Bad and the Ugly

Dr. Oettgen

"HDL is considered good cholesterol because it's responsible for removing LDL or bad cholesterol from blood vessels and helps limit plaque formation in arteries," said Oettgen. "Triglycerides are connected to cholesterol and if they increase, there is often a corresponding decrease in HDL levels."

High triglycerides and LDL can contribute to hardening or thickening of the artery walls ( atherosclerosis), which can raise the risk of heart disease, heart attacks or strokes. Low HDL levels and high triglycerides are red flags for metabolic syndrome, which increase risk for diabetes and atherosclerosis.

Oettgen recommends several strategies to manage cholesterol and triglyceride levels.

  • For patients who have low HDL levels and normal triglycerides, regular aerobic exercise is the best approach, along with taking 1500-2000 mg. of niacin, a B vitamin, daily.
  • Low HDL levels and high triglycerides may be resolved by eating a diet with reduced carbohydrates, both simple (natural and artificial sugars, like fruit and candy) and complex (starches like potatoes and bread), since these stimulate triglycerides. Oettgen also advises this group to avoid alcohol, increase physical activity and take 1-2 grams of fish-oil supplements daily. (Omega-3 fatty acid supplements could affect other medications you're taking, so check with your doctor first.) Most people will find that their HDL levels will rise as triglycerides normalize.
  • High triglycerides with normal HDL and LDL levels are an unusual occurrence and may be a sign of pancreatitis or inflammation of the pancreas.

The Medical Approach

"If these lifestyle changes are not effective, patients will generally receive a prescription for fibrate medications, such as fenofibrate (Lofibra, TriCor) and gemfibrozil (Lopid), to lower triglyceride levels and raise HDL levels," said Oettgen. "Prescription statins can also be used to normalize cholesterol levels."

Here are guidelines on optimal lipid levels:

  • Triglycerides: Less than 150
  • LDL Cholesterol: Less than 100
  • HDL Cholesterol: 60 or higher

"Routine testing of cholesterol and triglyceride levels is important, even at a young age and particularly if there's a strong family history of heart disease," said Oettgen. "It's a fairly easy screening process. Atherosclerosis develops slowly over many years, so if issues are addressed early, you are more likely to normalize levels. Just as with planning for retirement, the earlier you start, the better off you are."

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted June 2011

Contact Information

CardioVascular Institute at
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215