First-ever large-scale, prospective study in African Americans with high cholesterol levels demonstrates Crestor helped
patients achieve cholesterol goals –

New data presented today at the American Heart Association’s Annual Scientific Sessions showed that AstraZeneca’s CRESTOR®
(rosuvastatin calcium) at 10 and 20 mg reduced LDL-C or “bad” cholesterol by 37 and 46 percent, compared to 32 and 39 percent
at similar doses with atorvastatin in African-American patients. CRESTOR also brought more patients in this study to National
Cholesterol Education Program Adult Treatment Panel III (ATP III) LDL-C goals than atorvastatin at milligram-equivalent doses
of 10 and 20 mg. ARIES (African American Rosuvastatin Investigation of Efficacy and Safety) is the first-ever large-scale,
prospective trial exclusively designed to compare the effects of statins in African-American patients, who have generally
been underrepresented in clinical trials.

“As an African American physician who treats a large number of African-American patients, the ARIES trial represents an
opportunity to demonstrate the efficacy and safety of statins in this high-risk, undertreated and underserved population,”
said Dr. Keith C. Ferdinand, clinical cardiologist and medical director of Heartbeats Life Center and the lead investigator
for ARIES. “ARIES is the first trial to demonstrate superiority in lowering LDL-cholesterol (bad cholesterol) in this
population using rosuvastatin (CRESTOR) compared to atorvastatin, comparing equal doses of each.”

ARIES is a six-week, randomized, controlled, open-label, multi-center trial designed to evaluate the efficacy of CRESTOR and
atorvastatin in African Americans with elevated cholesterol. After a six-week dietary lead-in, 774 African-American adults
with hypercholesterolemia were randomized to one of four open-label treatments for six weeks: CRESTOR 10 or 20 mg or
atorvastatin 10 or 20 mg. Results showed CRESTOR 10 and 20 mg reduced LDL-C by 37 and 46 percent respectively compared with
32 and 39 percent for atorvastatin at the same dosages (p

– CRESTOR 10 and 20 mg reduced total cholesterol by 27 and 33 percent compared with 23 and 29 percent for atorvastatin 10
and 20 mg (p

Results from the ARIES study presented today at the American Heart Association’s Annual Scientific Sessions demonstrate
that CRESTOR 10 and 20mg reduce LDL-cholesterol (LDL-C or “bad” cholesterol) significantly more and raise HDL-cholesterol
(HDL-C or “good” cholesterol) more than atorvastatin 10 and 20mg in African Americans with hypercholesterolaemia, and enable
more patients to achieve their US NCEP ATP III guideline LDL-C goals.

Cardiovascular disease (CVD) is estimated to account for approximately a third of all deaths globally and is the leading
cause of mortality in the US. African Americans have higher CVD and stroke death rates than Caucasians, and approximately 40
percent of African American men and women age 20 and older have CVD.

“As an African American physician who treats a large number of African-American patients, the ARIES trial represents an
opportunity to demonstrate the efficacy and safety of statins in this high-risk, undertreated and underserved population,”
said Dr. Keith C. Ferdinand, clinical cardiologist and medical director of Heartbeats Life Center and the lead investigator
for ARIES. “ARIES is the first trial to demonstrate superiority in lowering LDL-cholesterol (bad cholesterol) in this
population using rosuvastatin (CRESTOR) compared to atorvastatin, comparing equal doses of each.”

Results from ARIES, involving 774 African American adults with hypercholesterolaemia, show that at six weeks:

– CRESTOR 10mg reduces LDL-C significantly more than atorvastatin 10mg (-37 percent versus -32 percent, respectively;
p

The so-called “bad cholesterol” – low-density lipoprotein commonly called LDL – may not be so bad after all, shows a Texas A&M University study that casts new light on the cholesterol debate, particularly among adults who exercise.

Steve Riechman, a researcher in the Department of Health and Kinesiology, says the study reveals that LDL is not the evil Darth Vader of health it has been made out to be in recent years and that new attitudes need to be adopted in regards to the substance. His work, with help from colleagues from the University of Pittsburgh, Kent State University, the Johns Hopkins Weight Management Center and the Northern Ontario School of Medicine, is published in the Journal of Gerontology.

Riechman and colleagues examined 52 adults from ages to 60 to 69 who were in generally good health but not physically active, and none of them were participating in a training program. The study showed that after fairly vigorous workouts, participants who had gained the most muscle mass also had the highest levels of LDL (bad) cholesterol, “a very unexpected result and one that surprised us.

“It shows that you do need a certain amount of LDL to gain more muscle mass. There’s no doubt you need both — the LDL and the HDL — and the truth is, it (cholesterol) is all good. You simply can’t remove all the ‘bad’ cholesterol from your body without serious problems occurring.

Cholesterol is found in all humans and is a type of fat around the body. A person’s total cholesterol level is comprised of LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol.

LDL is almost always referred to as the “bad” cholesterol because it tends to build up in the walls of arteries, causing a slowing of the blood flow which often leads to heart disease and heart attacks.

HDL, usually called the “good cholesterol,” often helps remove cholesterol from arteries.

“But here is where people tend to get things wrong,” Riechman says.

“LDL serves a very useful purpose. It acts as a warning sign that something is wrong and it signals the body to these warning signs. It does its job the way it is supposed to.

“People often say, ‘I want to get rid of all my bad (LDL) cholesterol,’ but the fact is, if you did so, you would die,” the Texas A&M professor adds. “Everyone needs a certain amount of both LDL and HDL in their bodies. We need to change this idea of LDL always being the evil thing ??” we all need it, and we need it to do its job.”

According to the American Heart Association, about 36 million American adults have high cholesterol levels.

“Our tissues need cholesterol, and LDL delivers it,” he notes. “HDL, the good cholesterol, cleans up after the repair is done. And the more LDL you have in your blood, the better you are able to build muscle during resistance training.”

Riechman says the study could be helpful in looking at a condition called sarcopenia, which is muscle loss due to aging. Previous studies show muscle is usually lost at a rate of 5 percent per decade after the age of 40, a huge concern since muscle mass is the major determinant of physical strength. After the age of 60, the prevalence of moderate to severe sarcopenia is found in about 65 percent of all men and about 30 percent of all women, and it accounts for more than $18 billion of health care costs in the United States.

“The bottom line is that LDL – the bad cholesterol – serves as a reminder that something is wrong and we need to find out what it is,” Riechman says.

“It gives us warning signs. Is smoking the problem, is it diet, is it lack of exercise that a person’s cholesterol is too high? It plays a very useful role, does the job it was intended to do, and we need to back off by always calling it ‘bad’ cholesterol because it is not totally bad.”

Source:
Texas A&M University

The National Lipid Association (NLA) today announced the publication of new recommendations in the May issue of the Journal of Clinical Lipidology for the screening, diagnosis and treatment of familial hypercholesterolemia (FH), an inherited condition marked by high LDL cholesterol typically starting in childhood. The NLA is simultaneously launching a consumer education program — FH, It’s Relative: Know Your Family Cholesterol History — which offers assessment tools and educational resources with the goal of improving early diagnosis by prompting family dialogue about cholesterol.

“It’s important that people know if a history of high cholesterol runs in their family,” explained Patrick M. Moriarty, M.D., professor of medicine at the University of Kansas Medical Center, National Lipid Association Member and an author of the FH recommendations. “Family discussions can lead to early diagnosis, which is critical because changes in diet and eating habits at a young age can help reduce the impact of FH later in life. Plus, treatment is more effective when started early, before cholesterol deposits in blood vessels become too advanced.”

According to the new recommendations, children with a family history of premature cardiovascular disease or elevated cholesterol should be screened for cholesterol beginning at age 2. Screening involves a simple blood test. The recommendations advise that universal cholesterol screening of all other children take place between the ages of 9 and 11.

“FH is more prevalent than cystic fibrosis, Down syndrome, and type 1 diabetes, yet it remains under-diagnosed and under-treated. Some estimates suggest that only about 20 percent of patients with FH are properly diagnosed and, of those, less than half receive appropriate treatment,” said Dr. Moriarty. “The NLA is committed to improving the lives of patients and is proud to focus its public education efforts this year on FH. If we can get families talking, we hope to make a real difference in helping patients get the care they need.”

Source:

National Lipid Association

Scientists have shed new light on how the phytosterol esters found in products such as Flora pro.activ help lower blood cholesterol. A major clinical study has tracked the interaction of phytosterol esters with digestion and metabolism of cholesterol directly in the intestine and its subsequent levels in the blood after eating.

The cholesterol-lowering effect of plant sterols has been known since the 1950s and repeatedly demonstrated in clinical trials. However, a recent study sponsored by Unilever, and in partnership with the French INSERM institute that conclusive proof that plant sterols esters markedly reduce free cholesterol availability in the intestine has been obtained. Previously, the precise mechanism by which plant sterol esters lower cholesterol was not fully understood.

The clinical study was carried out in Marseille, France and involved 12 male subjects. Each subject drank 500mL of liquid meal which contained deuterium enriched cholesterol and in the test product phytosterol esters. Samples were then taken at fixed time points from a tube in their small intestine and blood from their arm. These samples were then analysed for their lipid composition. In-Vitro, experiments were also carried out to corroborate the clinical results.

The results showed that plant sterol esters reduced the presence of meal-derived hepta-deuterated cholesterol in the circulation, and reduced the accumulation of cholesterol in the intestinal phase of digestion. This resulted in reduced cholesterol incorporation into micelles and vesicles, hence less cholesterol was absorbed.

The results have recently been published in the Journal of Lipid Research, and Guus Duchateau (Science leader Bioavailability & ADME*, Nutrition & Health) from Vlaardingen was one of the authors. Speaking about the research he said “To the best of our knowledge this was one of the most invasive clinical trials ever carried out by Unilever R&D. It took a lot of preparation but what a success! Even now we are submitting a second, follow up paper from the same data set”.

The World Health Organisation has estimated that 80% of coronary heart disease (CHD) and stroke cases could be prevented by implementing positive diet and lifestyle changes.1 Such changes include the uptake of a healthier diet, increasing physical activity and cessation of smoking.Elevated LDL cholesterol is widely accepted as one of the key modifiable risk factors associated with CHD.2

Wendy Duncan, Senior Nutrition & Health Nutrition Manager at Unilever says: “We have a long history of supporting scientific research into cholesterol and being at the forefront of its management through diet and lifestyle. This study was carried out as part of the ongoing support of science by Unilever. Our scientists will continue to closely monitor developments in cholesterol and plant sterol and stanol research, and will continue to progress our products and ranges accordingly.”

1. World Health Organisation (WHO). WHO Technical Report Series 916, Geneva, 2003

2. Tolonen H et al. Int J Epidemiol 2005; 34(1): 181-192

Source:

Flora pro.activ

Today, at the European Atherosclerosis Society (EAS) congress, Kowa
Pharmaceutical Europe announced results from a post marketing surveillance
study showing pitavastatin provides consistent long-term increases in
high-density lipoprotein cholesterol (HDL-C) in a broad range of patients
with hypercholesterolaemia.[1]

The data from the Livalo Effectiveness and Safety (LIVES) Study
Extension showed a relationship between on-treatment serum HDL-C levels and
cardiovascular risk, and that pitavastatin consistently provided clinically
relevant elevations in HDL-C that continued to increase over five years. [1]

“The results of the LIVES Study Extension highlight the benefits of
pitavastatin in patients at risk of cardiovascular disease (CVD). Not only
does pitavastatin consistently increase HDL-C levels, but it also has
additional patient benefits that help to reduce CVD. We very much look
forward to seeing the full results anticipated at a later date,” said
Professor Tamio Teramoto, Dean and Chairman of Internal Medicine, Teikyo
University School of Medicine, Japan.

Recently published guidance from the EAS recommends that physicians
target elevated LDL-C and decreased HDL-C, both of which are recognised as
risk factors for CVD. Study results have shown that pitavastatin could be
beneficial to patients as it reduces LDL-C and consistently raises HDL-C
over long-term treatment. [1]

In addition, further Kowa data is being announced at EAS, which
demonstrates that pitavastatin has beneficial anti-oxidative and
anti-inflammatory effects, in addition to its direct effects on cholesterol
levels. The additional benefits of pitavastatin include consistently
decreasing levels of oxidized low-density lipoprotein (Ox-LDL) and high
sensitivity C-reactive protein (hs-CRP) in at-risk patients during long-term
treatment. Both of these are associated with atherosclerosis.[2]

About Livazo(R)

Pitavastatin (a statin) is a fully synthetic and highly potent inhibitor
of HMG-CoA reductase used for primary hypercholesterolemia and combined
dyslipidemia. Pitavastatin has a novel cyclopropyl group on the base
structure common to the statin class. Since its 2003 launch in Japan,
pitavastatin has accumulated millions of patient-years of exposure. Many of
these patients have co-morbidities and are taking multiple medications. Kowa
received FDA approval of pitavastatin (Livalo(R)) for the treatment of
primary hyperlipidemia or mixed dyslipidemia in August 2009 and it was
launched in the U.S. in June 2010. Additionally, Kowa filed in Europe in
August 2008 using the decentralised authorisation procedure and received
regulatory approval in mid 2010. In much of Europe, pitavastatin will be
marketed by Recordati as Livazo. Pitavastatin will be available in three
dosage strengths (1 mg, 2 mg and 4 mg).

Pitavastatin launched in Lebanon and Spain in 2011; other European and
Middle Eastern launches are planned for 2011 and 2012.

1. Hounslow, N. Pitavastatin provides long-term improvements in
HDL-cholesterol in a range of patients with dyslipidaemia:results from a
phase III study programme. Abstract presented at EAS. June, 2011

2. Hounslow, N. Pitavastatin has pleiotropic antioxidative and
anti-inflammatory benefits in patients with dyslipidaemia:results from a
phase III study programme. Abstract presented at EAS. June, 2011

Source:

Kowa Pharmaceutical Europe (KPE) Co. Ltd

View drug information on Livalo.

Elevated blood cholesterol levels are regarded as a risk factor for heart attacks and other cardiovascular diseases. However, this does not necessarily mean that every cholesterol-lowering drug can also prevent heart attacks. For example, the benefit of the cholesterol-lowering drug ezetimibe is unclear. In particular, proof is lacking that patients have a greater benefit if they take ezetimibe in addition to statins for the prevention of heart attacks. This is the result of the final report published by the German Institute for Quality and Efficiency in Health Care (IQWiG) on 12 September 2011.

Prescribed largely in combination with statins

Ezetimibe is a cholesterol-absorption inhibitor. If taken orally, it acts in the small intestine by inhibiting the absorption of cholesterol into the body from ingested food, which leads to a reduction in blood cholesterol levels. It is hoped that this also reduces the risk of heart disease. Ezetimibe is currently prescribed mainly in combination with a statin, which is also used for the prevention of heart attacks in certain patients. For specific statins, various studies have demonstrated that in such patients they not only lower cholesterol levels but may also prevent heart attacks and other cardiovascular complications. Patients with elevated cholesterol levels who do not tolerate these drugs can also take ezetimibe without a statin.

IQWiG has now investigated whether ezetimibe – particularly in combination with statins – also lowers the risk of the complications mentioned.

Benefit of combination therapy not proven

A total of 2 studies were identified for the benefit assessment. In both studies, all patients received a statin as basic therapy. In the 24-month ENHANCE study, one half of the study participants additionally received ezetimibe, the others placebo. In the 14-month ARBITER-6-HALTS study, ezetimibe was compared with niacin (nicotinic acid). Relevant studies investigating ezetimibe as monotherapy were not available.

IQWiG analysed the results of the ENHANCE and ARBITER-6-HALTS studies particularly with regard to deaths, cardiovascular complications, health-related quality of life, and adverse effects. With regard to patient-relevant outcomes, neither of the 2 studies showed robust differences between the group of patients receiving ezetimibe plus a statin and the control group.

In summary, the data provide no indication that ezetimibe shows more benefit or harm than niacin or placebo. However, the studies available so far are too small and too short to conclusively clarify the benefit and harm of this drug.

The attention of health care professionals is currently focused on an ongoing study (IMPROVE-IT). It is the first study with the primary aim of comparing the effect of simvastatin plus ezetimibe versus simvastatin plus placebo on cardiovascular outcomes. The study includes high-risk patients with acute coronary syndrome whose condition has already been stabilized. The results are expected in 2013.

Procedure of report production

IQWiG published the preliminary results in the form of the preliminary report at the beginning of May 2011 and interested parties were invited to submit comments. When the comments stage ended, the preliminary report was revised and sent as a final report to the contracting agency, the Federal Joint Committee, in July 2011. Only one written comment was received, which was published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.

An overview of the background, methods and further results of the final report is provided in the executive summary.*

A new study from Rhode Island Hospital researchers suggests that controlling cholesterol may be important for heart health in patients who are taking non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen. The findings are based on a study on the safety of NSAID medications in clinically relevant animal models when high cholesterol is a factor. The study is published in the current issue of the journal Surgery.

NSAIDs are among the most widely-used drugs today for the treatment of post-operative pain, inflammatory conditions and fever. Despite that, the factors that affect their cardiovascular safety are not well understood and some studies suggest that there may be an increased incidence of cardiovascular complications such as heart attack or death.

This study, led by principal investigator Frank Sellke, M.D., chief of cardiothoracic surgery and research at Rhode Island Hospital, developed an animal model of hypercholesterolemia in swine to investigate the formation of collateral vessels and other effects in the heart, and the safety of NSAID and other medications.

Through their study, Sellke says, “We found that a high-cholesterol diet reduced blood flow to the heart muscle in our animal models with chronic heart disease when given daily naproxen. We also found reduced levels of prostacyclin, a compound that dilates blood vessels and prevents blood clots. These findings suggest that there may be a stronger risk of negative effects on the heart in patients who have high cholesterol levels and are taking NSAIDs as a form of pain or inflammation relief.”

The researchers compared two groups within the animal model, one with a normal diet, and one group that received a diet high in cholesterol, and both groups received daily naproxen. The animals also underwent surgery to simulate coronary artery disease, which affects many human patients who take NSAIDs. Several differences were found between the two groups.

Compared to animals with normal cholesterol, the high-cholesterol animals treated with naproxen had lower blood flow to the heart, decreased levels of prostacyclin, and decreased levels of several proteins that promote cardiac cell survival. In addition, previous studies by the group showed that while naproxen helped increased blood flow in the hearts of animals with normal cholesterol, this effect was not seen in animals with high cholesterol.

Sellke says, “These results show that high blood cholesterol levels change the way naproxen affects the heart, and alters blood flow to the heart. This ‘myocardial perfusion’ may be one predictor of angina frequency and quality of life in patients with chronic ischemia. Thus, these findings may have important implications for cardiac patients taking NSAIDs.”

First author Louis Chu, M.D., who worked with Sellke on the study, adds, “Our study indicates that physicians should be aware that cholesterol control may be especially important if patients are taking NSAID medications such as naproxen.”

Sellke adds, “While the results of these animal experiments are interesting and may provide information regarding the effect of a high fat diet on the response to naproxen and other similar medications, one cannot make definitive statements on the effect of these medications on patients without first doing clinical studies.”

The first single tablet for both diabetes type 2 and high cholesterol, Juvisync (sitagliptin and simvastatin), has been approved by the FDA (Food and Drug Administration). Sitagliptin and simvastatin are previously approved medications to separately treat elevated sugar and high cholesterol respectively. The new tablet, Juvisync, is an FDC (fixed-dose combination) of the two medications.

Approximately 20 million individuals in America have diabetes type 2. A high proportion of them also suffer from high cholesterol levels. High cholesterol can lead to kidney disease, blindness, heart disease, and stroke, especially if the condition is poorly controlled.

Sitagliptin is already approved, in combination with exercise and diet to improve glycemic control in diabetes type 2 adults. It is a dipeptidyl peptidase 4 (DPP-4) inhibitor, it improves the patient’s body’s ability to lower high blood sugar levels.

Simvastatin is a cholesterol-lowering drug, a statin. It specifically lowers LDL-C, known as low-density lipoprotein cholesterol, also known as “bad cholesterol. Simvastatin is an HMG-CoA reductase inhibitor.

Mary H. Parks, M.D., director of the Division of Metabolism and Endocrinology Products in the FDA’s Center for Drug Evaluation and Research, said:

“This is the first product to combine a type 2 diabetes drug with a cholesterol lowering drug in one tablet. However, to ensure safe and effective use of this product, tablets containing different doses of sitagliptin and simvastatin in fixed-dose combination have been developed to meet the different needs of individual patients. Dose selection should factor in what other drugs the patient is taking.”

The FDA informs that this fixed-dose combination is based on considerable experience with both simvastatin and sitagliptin, and the ability of the single tablet to deliver similar drug doses into the bloodstream as when the separate active ingredients are taken separately.

The Agency stressed on its website that Juvisync should only be prescribed to patients who are suitable for both medications simultaneously.

The FDA has approved Juvisync tablets in the following sitagliptin/simvastatin dosages – 100 mg/10 mg, 100 mg/20 mg and 100 mg/40 mg. The FDA added “Pending availability of the FDC tablets containing 50 mg of sitagliptin, patients who require this dose should continue to use the single ingredient sitagliptin tablet. There is no plan to develop FDCs with the sitagliptin 25 mg dose as use of this dose is quite low.”

Simvastatin is currently available in 5, 10, 20, 40 and 80 mg dosage strengths. There will be no fixed-dose combinations with 80mg simvastatin because of muscle toxicity risk, the FDA informs. There is no plan for a 5 mg simvastatin content in the combination tablet either.

There is a potential for statins to raise blood glucose levels in people with diabetes type 2. However, the FDA says it is a small risk, which is outweighed by the benefits in reducing heart disease among patients with diabetes.

Doctors will be informed of the small risk associated with Juvisync in the prescribing information. The company (MSD International) will have to carry out a post-marketing clinical trial comparing sitagliptin’s glucose lowering ability on its own and when combined with simvastatin.

Juvisync’s most common side effects include runny nose, stuffy nose, sore throat, headache, constipation, nausea, stomach pain, and upper respiratory infection.

Juvisync is manufactured by MSD International GmbH Clonmel, Co. in Tipperary, Ireland.

View drug information on Juvisync.

Increasing levels of high-density lipoproteins, better known as HDL or “good” cholesterol, reduced the risk for heart attack and stroke among patients with diabetes. That’s according to a new study appearing online in The American Journal of Cardiology.

The observational study, one of the largest of its kind, examined the medical records of more than 30,000 patients with diabetes and also found that patients whose HDL levels decreased had more heart attacks and strokes.

Researchers studied patients with diabetes because they are more prone to heart disease with a lifetime risk as high as 87 percent, according to a paper from the landmark Framingham heart study published 2008. While there is considerable evidence that reducing the amount of low-density lipoprotein, also known as LDL or “bad” cholesterol, can reduce the risk of heart disease, the relationship between HDL cholesterol and heart disease is less clear.

“Our study adds to the growing body of evidence that raising HDL levels may be an important strategy for reducing heart attack risk,” said study lead author Gregory Nichols, PhD, senior investigator with the Kaiser Permanente Center for Health Research in Portland, Ore.

“This is promising news for patients with diabetes, who already have an increased risk for heart problems. Raising their good cholesterol may be one more way for these patients to reduce their risk,” said Suma Vupputuri, PhD, co-author and investigator with the Kaiser Permanente Center for Health Research in Atlanta.

The study included 30,067 patients who entered Kaiser Permanente diabetes registries in Oregon, Washington and Georgia between 2001 and 2006. These patients had at least two HDL cholesterol measurements between 6 and 24 months apart. Most patients (61 percent) had no significant change in HDL levels; in 22 percent of patients, HDL levels increased by at least 6.5 mg/dl (milligrams per deciliter of blood); in 17 percent of patients, HDL levels decreased by at least that same amount. After obtaining the cholesterol measurement, researchers followed the patients for up to 8 years to see if they were hospitalized for a heart attack or stroke. Patients whose HDL levels increased had 8 percent fewer heart attacks and strokes than patients whose HDL levels remained the same, while patients whose HDL levels decreased had 11 percent more heart attacks and strokes. This study was observational so there was no intervention to change HDL levels, and although many patients were on statins to reduce their “bad” cholesterol, very few were on medications to improve HDL.

Past studies on this topic have reached contradictory conclusions. A study published in 2009 in the Archives of Internal Medicine found that for every 5 mg/dl improvement in HDL cholesterol level patients saw a 21 percent decrease in heart attack risk. But a systematic review of more than 100 clinical trials published in the British Medical Journal in 2009 found that increasing HDL cholesterol did not reduce the risk of heart disease or death.

Earlier this year the National Institutes of Health stopped a clinical trial using large doses of the B Vitamin niacin to boost HDL levels because the patients, who were already taking statins to reduce their “bad” cholesterol, saw no added reduction in heart attacks when they added niacin. Niacin is one of very few medications to increase HDL, but it can also have side effects such as flushing, vomiting, dizziness and itching.

People can raise their HDL levels without medication by keeping their weight down, changing their diet, avoiding tobacco smoke, and increasing exercise. Medical experts believe that HDL or “good” cholesterol carries the “bad” cholesterol away from the arteries and back to the liver where it is processed and passed from the body. According to the American Diabetes Association, a good target for women should be at least 50 mg/dl of HDL and for men at least 40 mg/dl. Levels of 60 mg/dl or higher are thought to protect against heart disease.