How to raise good cholesterol and lower bad
DEAR DR. DONOHUE: I am a healthy male in my 50s. A recent blood test showed my total cholesterol to be 173 (4.5). But my HDL cholesterol is too low, and my LDL cholesterol is not low enough. How do I take care of these two items? I watch my diet and exercise daily. — S.S.
ANSWER: We’re told to get our total cholesterol to a value less than 200 mg/dL (5.2 mmol/L). Yours is excellent.
HDL cholesterol, the good cholesterol, takes artery-clogging cholesterol to the liver for disposal. A man’s HDL cholesterol should be higher than 40 (1.04) and a woman’s higher than 50 (1.3). LDL cholesterol is bad cholesterol, the kind that fills arteries with gunk. People with no heart disease risk can have a reading under 160 (4.1) without health consequences; those with two risk factors should have an LDL lower than 130 (3.4), and those with more risks ought to strive for a reading under 100 (2.6). Anyone who has had a heart attack needs a value of 70 (1.8) or lower. “Risk factors” include a family history of heart disease, cigarette smoking, obesity, large waist measurements, high blood pressure, diabetes and a sedentary life.
Intense aerobic exercise and weight reduction boost HDL. Aerobic exercise is brisk walking, jogging, swimming and bike-riding. Red wine (and perhaps other alcoholic drinks) raises HDL. One drink a day is enough for women; two for men. If these measures aren’t raising HDL, medicines like niacin, statins and fibrates (not fiber) can boost it.
Physical activity and weight loss lower LDL cholesterol. Diet is important. Avoid trans fats, the fats found in many commercial foods like baked goods. The trans fat content of food is listed on labels. In place of butter, use oils — olive, canola, soy and flaxseed. Two fish meals a week lower it, as do nuts. Limit your use of sugar and white flour. The statin drugs, the ones usually prescribed for cholesterol-lowering, also bring down LDL.
DEAR DR. DONOHUE: About two weeks ago I saw the tail end of a TV show that demonstrated a new procedure to repair an aortic aneurysm. It showed a balloon being inserted into the aneurysm. Will you please address this procedure? — R.S.
ANSWER: I believe you’re asking about endovascular repair of aortic aneurysms. An aneurysm is a bulge in an artery, a weak spot. The aorta is the body’s largest artery. It starts at the heart and runs down the chest and into the abdomen. At the lowest part of the abdomen, it divides into two arteries, one for each leg. The abdominal aorta is the site of many aneurysms. If the bulge reaches a size of 5 to 5.5 cm (2 to 2.2 inches), the aneurysm is in danger of bursting open and causing a lethal hemorrhage.
In an endovascular repair, a pliable catheter is inserted into a surface artery, usually a groin artery, and snaked to the site of the aneurysm. The catheter comes equipped with a polyester tube that the doctor deploys when the aneurysm site is reached. Metal stents expand the polyester tube so it completely covers the bulging aneurysm. This repair greatly decreases the time of recuperation from patching up an aneurysm.
DEAR DR. DONOHUE: I am looking for information on Wegener’s granulomatosis. I have a friend who has had it for two years. He’s trying to reach a maintenance dose of prednisone, but he gets a flare-up when the medicine is reduced. What do high levels of prednisone do to the body? — E.M.
ANSWER: Wegener’s is an inflammation of medium and small arteries along with formation of granulomas — heaps of dead cells that are destructive to organs and tissue. The respiratory tract and other organs are affected, including kidneys, joints, muscles and skin. Prednisone, one of the cortisone medicines, is used for control. Often, it’s combined with another medicine so the prednisone dose can be lessened — cyclophosphamide, methotrexate and azathioprine are some of those drugs.
In high doses, prednisone can bring on diabetes, cataracts, osteoporosis, infections and suppression of the adrenal glands. Sometimes those side effects must be tolerated in order to control a devastating illness like Wegener’s.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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