Harvard Health Letter

Elevating your HDL game

"Good" cholesterol levels can be increased in several ways, but taking niacin is the most effective.

Until fairly recently, all eyes have been on low-density lipoprotein (LDL) cholesterol as the target for prevention of heart attacks and, to a lesser degree, strokes. Lowering LDL became the goal partly because we had the medications to do it. The statin drugs, which include Lipitor, Zocor, and several varieties now available as generics, are effective. In studies, each 40 milligrams per deciliter (mg/dL) decrease in LDL achieved with a statin has translated, on average, into a 24% decrease in the risk of having a heart attack, stroke, or other major cardiovascular event.

But many people with low LDL levels still have heart attacks and strokes, so doctors — and, yes, drug companies — have been looking for other factors to ratchet down, or up, that might lower cardiovascular disease risk. One contender is C-reactive protein (CRP), a marker for the low-level inflammation that seems to play an important role in the development of heart disease. In 2010, the FDA allowed the maker of rosuvastatin (Crestor), a powerful statin, to market the drug for use in people with perfectly normal LDL levels but who have high CRP levels (2 mg/L or higher) and at least one other cardiovascular risk factor (high blood pressure, for example).

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