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    Old 10-18-2007, 08:40 PM   #1
    Arizona77
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    What is considered a good HDL level?

    My HDL is currently at 42 and was advised it was fine as for men it needs to be above 40 and for women above 50. I am currently taking Niacin under my Doctor’s care to help boost my HDL more. What I have heard optimal HDL level is 60 or above and the higher the better. My Doctor told me that they are 78% concerned about your LDL and 22% concerned about your HDL. I am just very confused as I see many have high LDL and do not seemed so concerned about it as they are more concerned about keeping their HDL high.

    Last edited by Arizona77; 10-18-2007 at 09:06 PM.

     
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    Old 10-18-2007, 09:47 PM   #2
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    Re: What is considered a good HDL level?

    HDL is thought to be good stuff as it is used to transport cholesterol back to the liver. The higher HDL is, the more cholesterol is supposedly being recycled to the liver, which in turn suggests that les of it is being used to lay down plaque and clog up the arteries. The guidline is that the total cholesterol:HDL ratio should be less than 4. The notion that HDL should be greater than 40 is probably derived from the idea that LDL should be less than 160 (4 x 40).

    This begs an interesting question. At the end of the day, does messing with these numbers actually make any difference? Ultimately, the numbers are what they are. They simply reflect the way the body works and it's state of health. While it may be true that high HDL is associated with reduced heart attack risk, I am not convinced that artificially increasing this number through diet, supplements, drugs or whatever actually reduces the amount of plaque being laid down on artery linings. I guess the same can be said about artificially reducing LDL....

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    Old 10-18-2007, 11:14 PM   #3
    Arizona77
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    Re: What is considered a good HDL level?

    Quote:
    Originally Posted by Mark1e;3264***
    HDL is thought to be good stuff as it is used to transport cholesterol back to the liver. The higher HDL is, the more cholesterol is supposedly being recycled to the liver, which in turn suggests that les of it is being used to lay down plaque and clog up the arteries. The guidline is that the total cholesterol:HDL ratio should be less than 4. The notion that HDL should be greater than 40 is probably derived from the idea that LDL should be less than 160 (4 x 40).

    This begs an interesting question. At the end of the day, does messing with these numbers actually make any difference? Ultimately, the numbers are what they are. They simply reflect the way the body works and it's state of health. While it may be true that high HDL is associated with reduced heart attack risk, I am not convinced that artificially increasing this number through diet, supplements, drugs or whatever actually reduces the amount of plaque being laid down on artery linings. I guess the same can be said about artificially reducing LDL....

    Mark
    Hi Mark,

    I agree with you fully. You can still have picture perfect cholesterol and have a heart attack it is a well known fact. Another interesting thing regarding HDL I heard a few years ago most Okinowian’s form Japan have an average HDL in the low 20’s yet they have one of the world’s highest life expectancies and do not have heart disease. As we know and as you mentioned cholesterol is only a small part of the picture.

    Last edited by Arizona77; 10-18-2007 at 11:20 PM.

     
    Old 10-19-2007, 06:31 PM   #4
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    Re: What is considered a good HDL level?

    Quote:
    Originally Posted by Arizona77 View Post
    Hi Mark,

    I agree with you fully. You can still have picture perfect cholesterol and have a heart attack it is a well known fact. Another interesting thing regarding HDL I heard a few years ago most Okinowian’s form Japan have an average HDL in the low 20’s yet they have one of the world’s highest life expectancies and do not have heart disease. As we know and as you mentioned cholesterol is only a small part of the picture.
    You both make great points. In the last month or two I've come accross some information that has helped for all this to make some sense. First off the standard cholesterol test that is used 95% of the time gives us very limited information.

    Recent research strongly indicates that the average size of the lipoprotien is very important in determining CHD risk. The most current thinking is more sd-LDL you have the higher your risk. This is most likely the reason the so much importance is placed on lowering LDL. The fact that they have meds to help with this is also a driving factor too I'm sure. If the total LDL is very low then the sd-LDL can't be extemely high.

    Now my question is why don't the doctors start using the tests that can give them them the most complete picture?
    I asked my Dr. and he told me the test was covered by the insurance so that's what he ordered. I don't think he would have used that option if I wouldn't have asked.

    My understanding is these test are about the same cost so what's the deal? My guess is that most Dr. do not know how to use the results. It seem that many have a difficult time with the standard test and would most likely have to do a little research to fully understand the additional data provided by these other tests. The medical world is one that moves at a snails pace. The things that are being discovered today won't be commonly applied for another 20 years. The bad news is that for many that will be to late. I think you've got to look out for yourself and spend some time researching to be sure your getting the most up to date advice and treatment.

     
    Old 10-19-2007, 09:11 PM   #5
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    Re: What is considered a good HDL level?

    Quote:
    Originally Posted by Red60 View Post
    .... my question is why don't the doctors start using the tests that can give them them the most complete picture?
    I asked my Dr. and he told me the test was covered by the insurance so that's what he ordered. I don't think he would have used that option if I wouldn't have asked.

    My understanding is these test are about the same cost so what's the deal? My guess is that most Dr. do not know how to use the results. ....
    As far as doctors are concerned, the general idea is that there is no point in testing for something if you can't fix it. The lipoprotein size profile is very pertinent as far as risk assessment is concerned. But there are no medications available that increases the number of large particles and/or reduces the number of small particles. If the results are bad, testing for it will only make the patient more anxious. So it is ignored by doctors.

    The problem with this thinking is that it results in the wrong thing being treated. And doctors end up treating the symptom rather than the cause. Targeting only blood glucose levels in type 2 diabetics is another case in point. Testing insulin levels would reveal development and progression of insulin resistance long before blood glucose starts rising. But there are no drugs out there that reduce insulin levels. So they are ignored, and doctors only start taking note when blood glucose levels rise. The entire treatment protocol is focused slamming the door shut after the horse has bolted.

    It is all just a big numbers game. And we are all to often manipulated by merciless vested interests. At the end of the day, 28% of us will die of heart disease, and no amount of drugs is going to change that. We would probably be a lot better off not dwelling on this, focusing on healthy lifestyle habits, and enjoying life for what it is.

    Mark
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    Old 10-21-2007, 12:24 PM   #6
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    Re: What is considered a good HDL level?

    Quote:
    Originally Posted by Mark1e View Post
    As far as doctors are concerned, the general idea is that there is no point in testing for something if you can't fix it. The lipoprotein size profile is very pertinent as far as risk assessment is concerned. But there are no medications available that increases the number of large particles and/or reduces the number of small particles. If the results are bad, testing for it will only make the patient more anxious. So it is ignored by doctors.

    The problem with this thinking is that it results in the wrong thing being treated. And doctors end up treating the symptom........

    Mark
    But from what I've read the lipoprotein size profile can be significatly improved with diet, the proper supplements, exersise and in some cases statin drugs. Possibly Dr. Davis's Track your Plaque plan is a scam. If so I've swallowed the hook and been reeled in. He claims to have reversed plaque using diet, supplements, exercise and medication. The results have been seen in a large number of people and verified by using CT heart scans. When you consider that plaque usually increases at a rate of about 30% a year and the typical statin treatment combined with a low fat diet only slow this to about 15-20% his claimed results are amazing. If you run accross any of his many articles take a few minutes and read thru them. I think you'll find they will be worth your time.

    Last edited by Red60; 10-21-2007 at 12:30 PM.

     
    Old 10-21-2007, 02:55 PM   #7
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    Re: What is considered a good HDL level?

    I agree that taking drugs without knowing if a problem exists is a shot in the dark. A heart scan reveals the extent of plaque buildup and is a far more reliable indicator of heart attack risk. Dr Davis goes on to suggest that the presence of plaque means that cholesterol needs to be further reduced, regardless of its initial level. I can't accept this. It is falling into the same old trap of blaming heart disease on cholesterol, which doesn't make sense to me. But it is good to see that Dr Davis relies heavily on the TLC approach (Therapeutic Lifestyle Counselling). Lifestyle is, after all, the ultimate driver of good health.

    <removed>

    That being the case, heart scan information is pretty useless. Heart attacks and strokes are caused by ruptures of benign looking plaque. So why bother looking at it ....
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    Last edited by mod-anon; 10-22-2007 at 12:09 AM. Reason: do not post copyrighted material

     
    Old 10-21-2007, 05:45 PM   #8
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    Re: What is considered a good HDL level?

    Mark, first off I always enjoy your posts. Your responses are always well worded and very informative and I nearly always find myself in agreement with your statements and your general health philosophy. In regards to your comments on Dr Steven Nissen quote.

    <removed>

    Quote:
    Dr Davis goes on to suggest that the presence of plaque means that cholesterol needs to be further reduced, regardless of its initial level. I can't accept this. It is falling into the same old trap of blaming heart disease on cholesterol, which doesn't make sense to me.
    I have some reservation about this also. I don't know if you have read Dr. Davis 60-60-60 goal LDL 60 HDL 60 TG 60. To me this seems really low. But in his defense these numbers are based on what he has seen produce positive results based on heartscan score. What I really find difficult to believe is that fewer than 5% of those he treats require statins to achieve these levels. His "Go To" meds are Fishoil, Niacin and Vitamin d3. He promotes a low carb moderate fat diet along with exercise. He also knows there are some undiscovered factors that play a part in CHD. He has seen patients that despite doing everything possible cannot seem to halt the advancement of the disease. If we can learn what is happening in these patients it might allow us to take another significant step foward in the fight.

    For me I would just like to get my HDL to a respectable level. I'm getting a VAP test in the morning hopefuly I'll get a little boost since I've quite smoking.

    Last edited by mod-anon; 10-22-2007 at 12:10 AM. Reason: do not post copyrighted material

     
    Old 10-22-2007, 04:51 PM   #9
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    Re: What is considered a good HDL level?

    I had my VAP test this morning also. When I called my pcp's office last week the nurse said the doctor couldn't see me until November 15, and asked me why I wanted to see him. I told her I wanted the VAP, full blood panel, c-reactive protein, and homosysteine test. She asked me what the VAP was, she never heard of it. I bet the doc doesn't know how to interpret the results either, and I'll need to research it myself.

    Many people may be on the stains unnecessarily if they have large particle LDL which doesn't stick to the arteries and HDL2 which is more protective than HDL1, but they will never know unless they have the VAP.

    There are potential financial losses to the drug companies if the VAP becomes standard, maybe that's the reason some doctors don't suggest it.

    I was talking about the VAP test today at my swimming pool club, and I was told by a female member that I was ripping off Medicare by taking this test, and she doesn't believe in preventative tests because it drives costs up!
    I responded by saying if a person has prevenative heart tests for a few thousand dollars and a slight blockage is detected, they could take Lipitor instead of having a $30,000 by-pass operation down the road, and that would save costs!

     
    Old 10-22-2007, 06:07 PM   #10
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    Re: What is considered a good HDL level?

    Since we are talking money here... how much does the VAP test cost...?

    And wouldn't the results of this test tell you the normal range of each component so that you would know how to interpret it...?

     
    Old 10-22-2007, 06:59 PM   #11
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    Re: What is considered a good HDL level?

    Quote:
    Originally Posted by VentureMan View Post
    Since we are talking money here... how much does the VAP test cost...?

    And wouldn't the results of this test tell you the normal range of each component so that you would know how to interpret it...?
    I'm not sure of the actual cost but they claim it is about the same as the routine cholesterol test. One of the down sides is that there are only a handful of labs with the equipment so the samples have to be sent out and it takes a while to get the results.

    There are actually three different commercially available lipoprotein tests.

    1. Gel electropheresis (GGE) GGE uses a gel with an electric field applied to cause lipoproteins to migrate, based on particle size and charge.

    2) Vertical auto-profile (VAP)--a form of centrifugation, or high-speed spinning of blood plasma to separate lipoprotein particles.

    3) Nuclear magnetic resonance (NMR)--places plasma in an NMR (also known as MRI) device to characterize blood proteins.

    From what I've read they are all good tests, each doctor may have his or her own preference. From what I've seen the NMR test may actually have some advantages over the others but in my case the VAP was selected because the Dr is familiar with it and his local lab is familiar with processing to the outside lab.

    I've looked at a Sample VAP Cholesterol test online and it doesn't look difficult to understand. All the ranges are defined and any risks are identified on the test. You and your Dr. would just have to figure out the best treatment strategy. That's where it would pay off to do your homework once you knew your true cholesterol profile. I'm not sure all doctors would know the best way to treat the different possible patterns.

    Last edited by Red60; 10-22-2007 at 07:02 PM.

     
    Old 10-22-2007, 07:19 PM   #12
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    Re: What is considered a good HDL level?

    Thanks for the explanation Red, I looked at the sample test, it's pretty cool the way it shows exactly which sub-type of cholesterol is in the blood. I can't wait to see my results, if I have small particle LDL with a high count like last time of 150, I'm going to ask the doc for Niaspan, even if my HDL is still 78 and HDL2.

    I saw one price of $65.00 for senior citizen screening (over 55), that's cheap enough to pay out of pocket. I'm on Medicare and it's covered.

     
    Old 10-22-2007, 08:08 PM   #13
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    Re: What is considered a good HDL level?

    If you do not get the fluhsing from niaspan, it's wonderful stuff. No side effects. I do get a bit of flushing at night, at times, but it's nothing... just throw off the covers and you are good to go.

    I like that there is no harsh side effects and it helps keep you cholesterol in check.

     
    Old 10-22-2007, 11:15 PM   #14
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    Re: What is considered a good HDL level?

    Hey Ventrueman,

    I have been on 1,000mg immediate release for two months now. I am very eager to see what 1,000mg immediate release does for my HDL. I hope by February I will see some results when I have my next test. The main purpose for my Doctor putting me on Niacin was to help raise my HDL. As of this past August my HDL was at 42.
    I hope this stuff works!!!!

    Last edited by Arizona77; 10-22-2007 at 11:17 PM.

     
    Old 10-23-2007, 05:44 AM   #15
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    Re: What is considered a good HDL level?

    Quote:
    Originally Posted by Mark1e;3264***
    HDL is thought to be good stuff as it is used to transport cholesterol back to the liver. The higher HDL is, the more cholesterol is supposedly being recycled to the liver, which in turn suggests that les of it is being used to lay down plaque and clog up the arteries. The guidline is that the total cholesterol:HDL ratio should be less than 4. The notion that HDL should be greater than 40 is probably derived from the idea that LDL should be less than 160 (4 x 40).

    This begs an interesting question. At the end of the day, does messing with these numbers actually make any difference? Ultimately, the numbers are what they are. They simply reflect the way the body works and it's state of health. While it may be true that high HDL is associated with reduced heart attack risk, I am not convinced that artificially increasing this number through diet, supplements, drugs or whatever actually reduces the amount of plaque being laid down on artery linings. I guess the same can be said about artificially reducing LDL....

    Mark
    You brought up an interesting point regarding artificially increasing HDL and LDL. I have been wondering if increasing the HDL via the methods you mention raises HDL1 or HDL2 (more protective) or both of them or if decreasing the LDL lowers the small or large particle LDL or both?

    What if Crestor, Niaspan, Policosanol, etc. are raising the least protective HDL1 but not the more protective HDL2? Would it still be beneficial to take them?

    What if the statins are decreasing the safer large particle LDL, but not the dangerous smaller one? This would mean the reduction of LDL looks good on paper, but the patient actually has more risk of heart disease.

    A poster on another thread said her doctor was happy that her TC went down to 200, but it was the HDL that decreased and he didn't seem to be concerned as long as the number looked good!

    The issue of numbers looking good reminds me of artificially raising bone density with biophosphonates like Fosamax. Fosamax does not build new bone, it stops the osteoblasts from tearing down the old bone and fills in the gaps left by osteoporosis. The patient's Dexa scan results look great now with an increase in bone density numbers, but is left with old brittle bone that was never remodeled and more likely to fracture.

    Last edited by jacal5; 10-23-2007 at 08:30 AM.

     
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