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Question 6#

A 58-year-old man who smokes cigarettes has a history of hypertension and asks about reducing his risk for myocardial infarction. A lipid profile shows low HDL cholesterol at 32 mg/dL.

Which of the following is an important recommendation in attempting to raise the HDL? 

A. Aspirin, 325 mg each day
B. Low-cholesterol diet
C. Vitamin E, 400 units each day
D. DHEA (dehydroepiandrosterone) supplementation
E. Exercise and smoking cessation

Correct Answer is E

Comment:

(NCEP, http://www.nhlbi.nih.gov/guidelines/cholesterol.) Within this group of choices, only exercise and smoking cessation have been shown to raise HDL. A low-cholesterol diet actually lowers HDL. Among current lipid-lowering medications, nicotinic acid has the most potent HDL-increasing effect at 15% to 35%, followed by fibric acids and then statins. Alcohol also increases the HDL level (HDL2 and HDL3 subfractions), thereby imparting some cardioprotective effect, but at the risk of cardiomyopathy, sudden death, hemorrhagic stroke, and other noncardiovascular problems among heavy drinkers. The cardiovascular system may benefit from aspirin (because of antiplatelet effects), but it has no effect on HDL. After initial enthusiasm for vitamin E, more recent studies have not shown consistent cardiovascular benefit from antioxidant vitamins. None of these raise HDL. DHEA supplements lower HDL values.