Concerned About Your Cholesterol? 10 Ways to Lower LDL and Raise HDL

Your doctor tells you that your level of LDL—the "bad" type of cholesterol—is too high, and, in a double whammy, he says that your level of HDL—the "good" cholesterol—is too low. So, you wonder, is there anything you can do to decrease the bad while increasing the good?

There are steps you can take to accomplish this. It's much easier to push LDL down than to push HDL up, but it's well worth the effort to strive to do both. A November study published in the Postgraduate Medical Journal found that increasing HDL levels in patients who are also aggressively lowering their LDL levels can reduce cardiovascular risk. An HDL level of 60 milligrams per deciliter or higher is believed to help protect against heart disease. Women's risk for heart disease rises significantly at HDL levels below 47 mg/dL; men are at particular risk if their HDL level falls below 37 mg/dL.

For LDL, a reading of 190 mg/dL or higher is considered to be very high, 160 to 189 is considered to be high, and 130 to 159 is considered to be borderline high. A level of 100 to 129 is considered to be near optimal; less than 100 is considered optimal for most people. But for those who are at very high risk for heart disease or have a history of heart trouble, a reading of less than 70 is preferred.

Depending on your cholesterol levels, successfully reaching your target levels will probably take a combination of medication and lifestyle and dietary changes. Among the changes you'll have to make: Stop smoking, work out, lose weight, and eat well, the PMJ study suggests.

If you're up to the task, here are 10 ways to lower your LDL and raise your HDL:

1. Taking a statin can lower LDL by 10 percent (at the lowest dose) to 55 percent (at the highest dose), says Robert H. Eckel, professor of medicine at the University of Colorado-Denver and past president of the American Heart Association. A small percentage of people who take statins experience severe myopathy, which is muscle discomfort or weakness. (Consider 7 reasons statin users shouldn't dismiss muscle pain.) Statins also bump up HDL, typically by 5 to 10 percent (that's only 2 to 4 mg/dL, not enough to make much of a difference). Other types of cholesterol-lowering medications are sometimes prescribed in combination with statins.

2. A cholesterol absorption inhibitor would be a likely next step for those who can't take statins because of side effects, Eckel says. There is only one such drug—ezetimibe (Zetia). A 2003 study in the journal Pharmacotherapy found that when given alone or in combination with other cholesterol-lowering medications, ezetimibe reduced LDL by 15 to 20 percent and raised HDL, but, as with a statin, not by much—2.5 to 5 percent.

3. Bile acid sequestrants can decrease LDL by about 10 to 20 percent, according to the National Heart, Lung, and Blood Institute. When combined with a statin, these medications can lower LDL by more than 40 percent. Medications in this class—cholestyramine, colestipol, and colesevelam—come in pill or powder form. The powder must be mixed with water or juice before being taken. These drugs offer an added benefit for diabetics: Recent research has shown they help to lower blood glucose levels.

4. Nicotinic acid, also known as niacin, is a water-soluble B vitamin that lowers LDL by 10 to 20 percent and is the only drug that can have a real impact on HDL, says Eckel. According to the NHLBI, it can lift HDL levels by 15 to 35 percent. A study published this month in Current Medical Research and Opinion says that niacin and fibrates (explained below) are underutilized—either alone or in combination with statins—to treat low HDL and high triglycerides (a kind of fat in the blood). Because most people who take niacin experience flushing of the skin and a warm feeling, particularly on the face, neck, and ears, up to half of those taking the medication choose to stop it, according to the Mayo Clinic.