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Medical Edge Newspaper Column from Mayo Clinic

EXERCISE STILL THE SUREST WAY TO INCREASE ‘GOOD’ CHOLESTEROL

DEAR MAYO CLINIC: I read about a study where infusions of a synthetic component of “good” cholesterol, or HDL, reduced artery disease in just five weeks in a small study. Is this a new way to prevent heart disease? — Booneville, Miss.

ANSWER: It’s an intriguing idea that is still being studied. Here’s why it has researchers’ attention: High-density lipoprotein cholesterol, the “good” cholesterol, helps remove the excess cholesterol from your bloodstream. High levels of HDL cholesterol are beneficial.

In general, an HDL below 40 milligrams per deciliter (mg/dL) is considered too low. If you have low levels of HDL, it is a risk factor for heart disease even if your low-density lipoprotein, the “bad” cholesterol, is in the normal range. Women generally have higher levels of HDL cholesterol than men, so a value in the low to mid-40s may indicate increased risk for women.

The idea behind the study you mentioned came when researchers noted a family in Milan, Italy, with very low HDL levels and little heart disease. The researchers wondered if this family benefited from a modified or super form of HDL that helped prevent heart disease.

In fact, family members shared an altered or mutant form of a primary protein present in HDL. It’s called apolipoprotein A-1 (apoA-1).

Researchers developed a synthetic form, called apoA-1 Milano, which was used in a study of 47 people with atherosclerosis — a condition where cholesterol deposits have narrowed artery walls.

After five weeks of infusions of apoA-1, participants showed a trend towards reduced blockages compared to people on a placebo. Larger studies are under way.

Even if those studies show positive results, using apoA-1 to increase HDL won’t be practical treatment in the near future because infusions require weekly visits to the doctor’s office.

There are other ways to raise HDL cholesterol. They include the familiar healthy lifestyle recommendations: lose weight and increase physical activity. Moderate alcohol consumption, for people who can drink alcohol safely, can also improve HDL levels.

Medication options are limited, too. Right now, medications to decrease LDL cholesterol are more effective than those used to increase HDL cholesterol.

Currently, researchers are testing at least one new drug that will significantly raise HDL cholesterol. It works by inhibiting an enzyme that breaks down HDL in the blood. While this approach increases the level of HDL cholesterol in the blood, it is not clear how much it will reduce the risk of heart disease.

In contrast, the apoA-1 Milano infusions put new HDL particles into the bloodstream. These new HDL particles then pick up cholesterol from other tissues, including cholesterol-rich plaques in the arteries.

— Thomas G. Allison, Ph.D., MPH, Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Additional Resources:
Treatment of Coronary Artery Disease
Appointment Information
More Information on Cholesterol

READERS: Foods — hot, cold, sweet or sour — can cause pain in a sensitive tooth. Touch or even air can be bothersome, too. Usually the pain stems from enamel erosion or gum recession. Here are some tips to take care of the problem:

— Use a desensitizing toothpaste. They contain compounds that help block sensation that might otherwise stimulate pain in the tooth’s nerve. Choose a product that displays the American Dental Association’s Seal of Acceptance.

— Avoid using whitening or tartar control toothpastes, as they may increase sensitivity to hot or cold.

— Brush properly. Use a soft toothbrush, and brush with short back-and-forth strokes and a gentle up-and-down motion. Brush thoroughly, and floss daily.

— See your dentist. If you still have discomfort when brushing, flossing, chewing or drinking, you may need dental treatment. Sometimes coating sensitive areas of affected teeth with a fluoride gel or special desensitizing agent helps. If the culprit is tooth decay, a cracked tooth or worn filling, these should be treated.

Additional Resources:
Sensitive Teeth
Appointment Information
More Information on Teeth
Caring for your Teeth

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.