A New Way to Raise ‘Good’ Cholesterol?

Meeting the challenge of increasing HDL

slice of orange and measuring tape

Drugs to reduce LDL, the “bad” cholesterol, have been around for decades. Until recently, though, researchers were puzzled by how to increase HDL, the “good” cholesterol.

A new drug under trial may help play a role in raising good cholesterol in the not-too-distant future.

What is cholesterol?

Cholesterol is a waxy substance found in every cell of the human body. It’s used to produce hormones and vitamin D, and it aids in digestion. Because the body produces all the cholesterol it needs, the additional cholesterol found in many foods is unnecessary.

Cholesterol is carried through the bloodstream in two kinds of lipoproteins: low-density (LDL) and high-density (HDL). It’s important to have healthy levels of both types.

HDL carries excess cholesterol to the liver, where it’s removed from the body. If, however, LDL cholesterol levels are too high beyond the ability of HDL to clear it, cholesterol can build up in the arteries. And too much cholesterol in the arteries can cause arteriosclerosis, a thickening of the arterial walls, which leads to reduced blood flow to the heart and brain and increases the risk of heart attack and stroke.

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You can raise HDL cholesterol levels by incorporating healthy dietary and lifestyle changes, such as quitting smoking, eating less red meat and dairy products and exercising more.

A promising new drug

Now a new drug, evacetrapib, shows promise in raising HDL.

Leading a study of evacetrapib is Stephen J. Nicholls, MBBS, PhD. Dr. Nicholls is beginning a Cleveland Clinic-led phase 3 clinical trial of the drug. The worldwide study involves over 11,000 patients in more than 30 countries.

“We’re moving forward to assess whether the medication reduces the likelihood that patients will have heart attacks and strokes,” Dr. Nicholls says.

Previous studies of several other drugs reported raised HDL levels in trial participants, but were stopped after researchers discovered associated health risks and a failure to reduce heart attack risk. In contrast, Dr. Nicholls says that early studies of evacetrapib showed no major side effects.

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 “We’re not really sure why it’s proving more difficult to increase HDL,” says Dr. Nicholls. “Decreasing LDL seems to be pretty straightforward. Medications that lower LDL typically reduce clinical events. Medications that raise HDL have variable effects on clinical events, and several have failed to protect in recent large trials. It may be that the way HDL is raised is particularly important.”

How the new drug works

Evacetrapib works by blocking a factor that normally allows transfer of cholesterol from the good form to the bad. As a result, the good form of cholesterol is raised, and the bad form is lowered. “We’d like to think that should be good for patients in terms of less risk of heart attack and stroke,” Dr. Nicholls says.

“Although preliminary studies are encouraging, the current clinical trial will take another three to four years,” says Dr. Nicholls. “Outcomes will then be studied and evaluated before the drug might be approved.”

Stephen J. Nicholls, MBBS, PhD, Medical Director of Intravascular Ultrasound and Angiography Core Laboratories and Clinical Director of the Center for Cardiovascular Diagnostics and Prevention at Cleveland Clinic. Currently in Australia as Professor of Cardiology at the South Australian Health & Medical Research Institute, Dr. Nicholls is beginning a phase 3 clinical trial of the drug, led by Cleveland Clinic.

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  • Cynthia Wick

    It is also possible through changed diet, and taking red rice yeast, to lower your cholesterol without taking a pill. After a visit to wonderful CC that is what I was told to do by my doctor, and I lowered my bad cholesterol by 40 points. I would love to see some natural solutions here also.

    • Jane F

      Exactly my thought when I read the article. Whenever drugs are suggested, the CC should tap it’s Nutritionists and Wellness Center for diet and exercise options, even when there aren’t any. It shows that CC is looking at all the options.

  • Charles D.

    Congratulations for the discoverings but it would be much better to teach us (encouraging) how to lower the bad cholesterol and raise the good one with a good nutrition system. It is time to start thinking and learning that drugs (in general) good for certain deseases or conditions are always bad for our health because they hurt other organs.

  • Vivian

    I use niacin and omega 3. Without the worry of the side effects I’m sure this pharma may bring!

    • Sue

      Vivian – You’re lucky you can tolerate the niacin. Neither my husband, daughter or brother-in-law could tolerate tne tingling.

  • Cristina

    There is a plant extract used in homeopathy called YUMEL which works terrific on lowering cholesterol, and it is not new at all, it’s been used for more than 200 yrs without any side effects…

  • The_Beating_Edge_Team

    In response to the many comments regarding this article, I asked Stanley Hazen, MD, PhD, Section Head, Preventive Cardiology, to comment. He stated the following. I hope this is helpful to everyone. betsyRN

    “Nutrition and exercise efforts are a cornerstone of cardiovascular health and wellness. Within the Preventive Cardiology Clinic, a team of physicians, nurse practitioners, registered dietitians, and exercise physiologists collectively work to individualize treatment and lifestyle recommendations. In this way we tailor a program for the individual aimed at optimal global cardiovascular risk reduction efforts. While
    some nutritional supplements and nutriceuticals are reasonable to try, and are
    incorporated into recommendations all the time, it is also important to realize
    that the FDA does not monitor nutritional supplements. In clinic we see all too
    often adverse side effects and significant laboratory abnormalities that can
    occur when taking some supplements. Further, many claims made by commercial
    vendors of these agents are not supported by rigorous trial studies.
    I therefore recommend that patients talk about their desire to do the “natural”
    approach with their physician, and work as a team with their health care
    providers to develop a tailored program that works best for the individual at
    lowering cardiovascular risks. This plan often involves a combination of natural
    and prescriptive approaches, and always is coupled with dietary efforts and
    lifestyle (exercise) programs.”

  • Shellie

    I would definitely vote for the “lifestyle” change over drugs when possible. And it is almost AWAYS possible!! All drugs have a toxic effect on the body. Unfortunately, we the patients want a quick fix, so our doctors and the money grabbing big Pharma companies have no problems helping us out. I would love for our doctors to get tough, and really push better lifestyles.