We all should be working at increasing our HDL cholesterol numbers, but people with diabetes type 2 in particular should make this a main goal because when HDL is high, the risk of heart disease goes down. We also know that diabetics can be vulnerable to heart disease.

Today I am bringing to you a study conducted by Kaiser Permanente. The study was sponsored by a pharmaceutical company (probably trying to justify the production of new drugs).

However, regardless of the main purpose behind the research, the study is very informative in that it shows that higher levels of HDL cholesterol (the good type) mean less cardiovascular incidents. And this is quite important, since some of those incidents can be fatal.

When it comes to a health issue, I always advocate trying first natural ways to remedy it. Actually, there are no medications in the market at this time that can be effective at raising HDL or that in the process of doing so, don’t cause severe side effects.

But there are a few things you can or avoid doing to boost your HDL cholesterol before taking medication. Here are some factors that can influence your HDL levels:

Factors that increase HDL

Regular physical activity, such as walking
If you are overweight, losing some weight
A diet high in fiber, especially soluble fiber
A diet low in refined carbohydrates
Including healthy fats such as olive oil
Including in your diet omega 3s from fish

Factors that decreases HDL

Trans fats or hydrogenated oils
Alcohol in excess
Refined carbohydrates
Low physical activity

The study in question was published in the American Journal of Cardiology and posted by MedPage Today on October 7, 2011.

Higher HDL Lowers Cardiovascular Risk in Type 2 Diabetes

Higher HDL levels in patients with type 2 diabetes significantly reduced the odds of hospitalization related to cardiovascular disease, data from a large cohort study showed.

Every 5 mg/dL increase in HDL was associated with a 6% reduction in the cardiovascular disease (CVD) hospitalization risk. During a follow-up of 55.8 months, each 5 mg/dL increase in HDL was associated with a 4% lower risk.

An analysis centered on HDL showed that a ≥6.5 mg/dl decrease was associated with an 11% increase in CVD risk, whereas a ≥6.5 mg/dL increase reduced the CVD hazard by 8%, as compared with individuals who remained within 6.4 mg/dL.

“Our results add to the growing body of evidence that increasing the HDL cholesterol levels might be an important strategy for CVD risk reduction,” Gregory A. Nichols, PhD, of Kaiser Permanente Center for Health Research in Portland, Ore., and co-authors wrote in an article published online in the American Journal of Cardiology.

“The prevention of HDL cholesterol decreases could be equally important,” they said.

Patients with type 2 diabetes have a substantially elevated risk of cardiovascular disease, with estimates ranging as high as 87% greater compared with non-diabetic adults. Reduction of LDL cholesterol remains the focus of lipid management to reduce CVD risk.

However, clinical trials of intensive LDL-lowering with statin drugs have shown that at least 10% of patients have major cardiovascular problems, the authors noted in their introduction.

Glycemic control remains the focus of diabetes management, although intensive hypoglycemic treatment has failed to reduce CVD risk in type 2 diabetics, they continued. The findings suggest that treatment targets other than LDL and hemoglobin A1c deserve consideration.

HDL cholesterol offers one potential target for CVD risk reduction in patients with type 2 diabetes. About half of diabetic patients have low HDL levels, an observation that has generated speculation that raising HDL levels might substantially reduce CVD risk in that patient population.

Clinical studies have yet to produce clear evidence that increasing HDL levels will reduce CVD risk in type 2 diabetes, possibly because of the lack of safe and effective agents, the authors continued.

Attempts to use drugs to raise HDL have generally been unsuccessful. Several trials of HDL-raising drugs have been stopped because of an increase in cardiovascular events and mortality including ILLUMINATE and AIM-HIGH.

The search continues, however, for a safe HDL-raising drug. Researchers reported at this year’s European Society of Cardiology meeting positive results for such a drug in the phase IIb dal-VESSEL trial, and the DEFINE trial, reported at last year’s American Heart Association meeting, showed good results for anacetrapib in terms of safety and efficacy.

In addition, the FDA on Oct. 7 approved Juvisync (sitagliptin and simvastatin), the first combination drug to treat type 2 diabetes and high cholesterol in one tablet.

The study by Kaiser

In an effort to inform on the association between HDL level and CVD risk in type 2 diabetes, Nichols and colleagues performed a retrospective cohort study of 30,067 members of the Kaiser Permanente Northwest and Georgia regions. All patients had type 2 diabetes and had at least two HDL cholesterol measurements during 2001 to 2006.

Investigators analyzed clinical data on the patients through 2009 to determine whether change in HDL cholesterol influenced subsequent risk of CVD-related hospitalization. They examined HDL cholesterol continuously and by three categories: HDL increase ≥6.5 mg/dL, decrease ≥6.5 mg/dL, and no increase or decrease >6.4 mg/dL.

During follow-up, 61% of the patients had HDL levels that remained within 6.4 mg/dL values, 21.6% had ≥6.5 mg/dL increases in HDL, and 17% had ≥6.5 mg/dL decreases.

The results of the study

The authors found that 3,023 (10.1%) patients had CVD-related hospitalizations during the follow-up period. After multivariate adjustment, they found that every 5 mg/dL greater baseline HDL level was associated with a statistically significant 6% reduction in the hazard for CVD hospitalization, and each 5 mg/dL increase from baseline was associated with a 4% reduction in CVD risk.

The analysis showed that every 6.5 mg/dL increase in HDL during follow-up was associated with an 8% reduction in CVD risk, which did not achieve statistical significance. However, each 6.5% or greater decrease in HDL was associated with a significant 11% increase in the CVD hospitalization hazard

The study was funded by Takeda Pharmaceuticals America.

Source reference:

Nichols GA, et al “Change in high-density lipoprotein cholesterol and risk of subsequent hospitalization for coronary artery disease or stroke among patients with type 2 diabetes mellitus” Am J Cardiol 2011; DOI: 10.1016/j.amjcard.2011.05.047 and MedPage Today.


I am Andy Carpenter and I would start by saying that I have a Bachelor Degree in Nutrition Science conferred by California State University, Los Angeles and that I am certified as a Registered Dietitian.

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