Although doctors were disappointed this week when Pfizer Inc. stopped clinical trials of a drug designed to boost levels of "good cholesterol," experts say there are other methods of increasing levels of protective, high-density lipoproteins (HDL) in the blood.
The bad news: most of them require willpower.
"The cornerstones are diet and exercise," said Dr. Roger Blumenthal, head of the preventive cardiology program at the Johns Hopkins School of Medicine. "The only real medication that has an impact on HDL is niacin."
Also known as vitamin B3, niacin has been used as a cholesterol medication for about 30 years and, according to Blumenthal, raises patients' HDL levels by 20 percent to 25 percent on average.
High levels of HDL have been shown to lower the risk for a heart attack, according to the American Heart Association. But the vitamin has some drawbacks. It dilates blood vessels, which can result in uncomfortable itching and flushing. "Only about three out of every four patients can tolerate it," Blumenthal said. Taking aspirin within 30 minutes of taking niacin and using a slow-release form of niacin can help prevent flushing.
Over-the-counter forms of niacin have also been linked to rare cases of liver failure, said Dr. Michael Miller, director of preventive cardiology at the University of Maryland Medical Center.
"At the doses you need to affect HDL, it's considered a medication," he said, "and needs to be monitored by your physician."
The National Heart, Lung and Blood Institute is conducting a clinical trial to determine whether niacin benefits patients who are also taking statins, drugs that reduce levels of low-density lipoprotein (LDL), the harmful form of cholesterol.
"Niacin has a long track record but it hasn't been studied in this context," said Miller, who is helping to conduct a portion of the trial at Maryland's medical center. The results of the trial are not expected for about five years, experts said.
Miller said he thinks that trial will turn out better than did tests on torcetrapib, a drug Pfizer developed to boost patients' helpful cholesterol.
Pfizer had recently launched a clinical trial involving 15,000 people, to test whether torcetrapib would complement statins in fighting heart disease.
But the drugmaker announced last week that it was ending the trial, after the drug was found to increase death rates among the trial participants.
"There are other [medications] to raise HDL, but they are further behind than the data was with torcetrapib," Blumenthal said.
Fortunately, drugs are only one means of improving levels of beneficial cholesterol.
A variety of "lifestyle changes" can also make a difference, said Rachel R. Mutchler, clinical nutrition manager at Baltimore's Sinai Hospital.
"The primary one - and nobody wants to hear this - is to exercise," she said. "Not everybody can run or lift heavy weights, but burning just 1,200 to 1,500 calories a week can have a dramatic effect on your HDL levels."
The same is true of giving up smoking. A study by researchers at Vanderbilt University found that within one week of quitting, smokers' HDL levels climbed substantially.
Mutchler said avoiding foods high in trans fatty acids, such as cookies, cakes, french fries and other fast food items, can also help.
Ignorance became less of an excuse for eating such foods when the Food and Drug Administration began requiring food manufacturers to include a product's trans fat content on its nutrition label.
Red meat, egg yolks and other foods high in bad cholesterol should also be avoided in favor of chicken and turkey.
On the other hand, flax seed oil and fish high in Omega 3 fatty acids, such as salmon, sardines, herring, mackerel and sea bass, have also been shown to boost HDL levels. Consuming one alcoholic drink a day also appears to increase good cholesterol, experts said.
They also suggest getting plenty of fiber from fruits and vegetables. Mutchler recommends oat and rice bran, almonds, acorn squash and broccoli as particularly good fiber sources.
Another way to boost HDL is to avoid downing lots of carbohydrates, particularly simple carbohydrates found in white rice, white bread and sugary treats. "This does not mean go on a low-carb diet," Mutchler said. "It just means eat carbohydrates in moderation."
"After cutting back on carbohydrates for a week or so your body will adapt," she said, "and you won't have those cravings anymore."