Dr. Stephen Devine is on a mission to raise levels of HDL, or the "good" cholesterol. Devine, a Gundersen Lutheran cardiologist who specializes in non-invasive ways to prevent heart disease, said low levels of HDL can lead to diabetes and heart disease. He and Dr. Brendan Doyle, a Mayo Clinic cardiologist who works at Franciscan Skemp, are seeing more patients with below-normal levels of HDL, which are putting them at greater risk for heart disease. Some of these same patients have a good side of their cholesterol profile -- normal or below-normal levels of total cholesterol and LDL, the "bad" cholesterol -- but lose some protective effects on their heart and vessels with low HDL. Devine said one-third of American males and 39 percent of American women have below-normal HDL levels. "When we look at the lipid profile, low HDL stands out," Devine said. "We have put an emphasis on HDL. It's too important to overlook it." Obesity, increased triglycerides, high blood pressure and high blood sugars often go hand-in-hand with low HDL levels, he said. "These patients have pre-diabetes, and they don't know it," Devine said. "I tell them frankly that they don't want diabetes and what can go with it -- blindness, kidney damage and leg amputation.
"My job is to prevent them going from pre-diabetes to diabetes," he said.
Devine recently saw a 22-year-old with chest pain who had pre-diabetes and didn't know it.
HDL levels are going down at an alarming rate, Devine said, and doctors need to treat patients with low HDL levels aggressively.
A study reported in the January issue of the American Heart Journal showed three-fourths of 136,000 heart attack patients had normal or low LDL, but poor levels of HDL.
Raising HDL levels may be the next frontier in reducing one's risk for heart disease, said the study's lead author, Dr. Greg Fonarow at UCLA.
Doyle agreed doctors are more concerned about raising HDL levels.
One problem doctors face, he said, is they can raise HDL with some medicines, but that may not translate to decreased risk for heart attacks or a longer life.
"Some drugs can change the number, but we don't see the clinical benefit," Doyle said. "The number is half the battle."
He said doctors know lifestyle factors such as smoking, obesity and being sedentary contributes to low HDL and pre-diabetes.
"We're more aggressively screening for risk factors," he said. "It's good to be aware of the numbers, but treatment options can be quite limited. That could change in the future with more research."
But Doyle said healthier lifestyles -- maintaining a healthy weight and a regular exercise program and not smoking -- will help reduce risk for heart disease. Some medications used to lower LDL may also increase HDL, such as niacin, fibrates and statins. If people have low LDL and low total cholesterol but also have low HDL, they still need to see their physician, Devine said. Jessica Aberg, a Gundersen Lutheran cardiology registered dietitian, works on dietary and lifestyle changes with patients to increase HDL levels. Aberg said her patients who have lost significant weight in three or four months often still have low HDL levels. "I've seeing more patients with low HDL, and they're always surprised their other cholesterol levels are fine," Aberg said. "HDL should be taken seriously, but raising it can take time."