Men's Health: High Cholesterol Can Save Your Life

Nov. 3, 2000 -- It takes a lot to scare a man who has performed 3,000 autopsies.

But Dr. Henry McGill discovered something terrifying when he reviewed 760 postmortems of young folks between the ages of 15 and 34.

Sure, many of the bodies were mangled from violent auto wrecks and homicides. Plenty of shotgun suicides, too. But that didn’t faze him. It was their hearts.

“These autopsies found that one out of five men in their early 30s had already developed a dangerous heart blockage,” explains McGill, a pathologist at the University of Texas Health Science Center in San Antonio. “I’m talking about fatty arterial blockages that would have killed them by the time they were 45 or 50. It was shocking.”

More Dangerous Than Smoking

He made another surprising discovery: Many of the dead men with the largest blockages had a common risk factor that proved to be statistically more dangerous even than smoking: The men had low levels of high-density-lipoprotein, or HDL, cholesterol. This is the beneficial type of cholesterol that removes harmful low-density-lipoprotein (LDL) particles from your cardiac arteries before they can choke off the bloodflow.

Unfortunately, says Dr. Michael Gaziano, a cardiologist at Brigham and Women’s Hospital in Boston, few men realize how critical HDL cholesterol is in preventing fatal heart attacks and strokes. For that matter, few family doctors do, either.

“When looking over blood-test results, most men focus on their LDL cholesterol level and completely ignore the HDL cholesterol count,” he explains. “This is a huge mistake — a third of men at risk of dying of heart disease have perfectly normal levels of LDL cholesterol.” The fact is, if you don’t have enough HDL cholesterol scouring your arteries, even low amounts of LDL cholesterol can form dangerous blockages.

So how much HDL is enough? Current guidelines say 35 milligrams per deciliter of blood (mg/dl) is normal, but most cardiologists would prefer you to have an HDL count that’s twice that. “The higher the better,” says Gaziano. “Once you get over 60 mg/dl, it’s a strong positive factor in avoiding heart disease.”

There are easy ways you can increase your HDL levels. We give 10 simple strategies below. Remember: You cut your risk of developing heart disease by 2 percent for every 1 mg/dl increase in HDL above 35 mg/dl. And, considering the atomic wedgies you gave the class president back in high school, you really don’t want to end up on the heart-transplant list.

Drink Orange Juice EverydayIf you’re built like 25 Canadians at the University of Western Ontario, this will increase your HDL by 21 percent (or 10 to 20 points) within 4 weeks. “We’re not sure, but this effect may be due to a flavonoid in orange juice called hesperidin,” says Elzbieta Kurowska, the study leader.

Run at Least 7 Miles a WeekOr burn 1,200 to 1,600 calories per week doing any type of aerobic exercise (best done in four 30-minute sessions). “At 7 miles a week, you see favorable HDL cholesterol changes,” explains Peter Kokkinos, a clinical exercise physiologist at Georgetown University who observed the effect in 3,000 men to determine this. And keep a moderate pace; injured men don’t exercise or receive the benefit, says Kokkinos.

Drop 10 Pounds“That’s where you see significant increases in your HDL cholesterol, anywhere from a 6- to a 10-point rise,” says Kokkinos. What’s more, for every pound of fat you lose, studies show you can expect a 1 percent rise in hdl. At a certain point you’ll waste away and die, of course, but your heart valves ought to be clean as hell.

Refuse to Drink White WineIt’s wimpy. More important, it doesn’t do anything to help your cholesterol profile, according to recent lab studies. “There are antioxidants in red wine that slow down the oxidation of both hdl and ldl cholesterol,” says Vincent Rifici, of the Robert Wood Johnson medical school in New Brunswick, N.J. This preventive effect may be doubly good: Oxidation can lower your HDL cholesterol count, and it also seems to encourage the formation of arterial plaques. “Cabernet sauvignon, pinot noir, and merlot all had similar antioxidant properties,” says Rifici. They all went nicely with the laboratory’s cheese plates, too.

Spread Peanut Butter on English MuffinPeanut butter is rich in monounsaturated fats, which studies have shown lower triglyceride and ldl cholesterol levels while maintaining your hdl levels. Olive oil, canola oil, pecans, and almonds are also good sources of monounsaturated fats.

Exercise Before You Eat Like a PigIn a study of 21 men at the University of Missouri, those who regularly exercised before eating high-fat meals had the highest hdl counts. Exercise stimulates a fat-clearing enzyme called lipoprotein lipase, which cuts triglycerides to help produce more hdl cholesterol. The more lipoprotein lipase circulating in your blood during a high-fat meal, the better. “The best strategy is to work out in the morning in preparation for dinner, which is usually the fattiest meal of the day,” says Tom Thomas, the study leader and an exercise physiologist.

Do Some Squats Before You Run“Resistance training causes cellular damage to your muscles, which may force them to burn more fat for energy during aerobic exercise,” says Thomas. “And fat-burning has a strong effect on raising HDL levels.”

Quit Smoking AgainA study of six people by Nashville’s Vanderbilt University school of medicine found that within just 1 week of quitting smoking, their HDL levels increased by 15 percent, or roughly 7 points. Researchers don’t know why smoking makes such a selective attack on HDL cholesterol; if lung cancer doesn’t get you, heart disease will.

Eat Red FoodsKidney beans, red beans, apples, tortellini pasta. (Wash it all down with red Kool-Aid, just for fun.) They’re all low-glycemic carbohydrates, which don’t cause an insulin spike during digestion. And that’s a good thing for your hdl count. A British study of 1,420 people found that those who had diets rich in low-glycemic foods like beans also had the highest levels of hdl cholesterol. Cut down on refined starches like white bread, instant potatoes, and white rice; they might reduce HDL cholesterol levels.

Pros and Cons of DrugsIf you fail to raise your HDL naturally, ask your doctor about HDL-boosting drugs. You’re a likely candidate to take them if (1) you still have an HDL count of less than 28 mg/dl, or (2) you have an HDL count of less than 35 mg/dl but also have two risk factors for heart disease, such as diabetes, obesity, or high blood pressure. If you’re on the border, ask your doctor to give you an ultrafast computed tomography (CT) scan to see if blockages are forming in your arteries, says Dr. Tedd Mitchell of the Cooper Clinic in Dallas.

Drugs such as niacin (a slow-release B vitamin sold under the brand name Niaspan) can raise your HDL levels by as much as 15 points. Some drugs work best in combination. “By mixing 750 mg of niacin with 10 mg of statins or gemifibrozil, my patients often achieve a 30 percent increase in HDL levels,” says Gaziano. What’s better, this tactic cuts the dosage of niacin you need, which strongly reduces the risks of developing common side effects such as flushing, heartburn, and liver damage.

Additional research by Carol Ann Shaheen.