Statin Therapy Does Not Improve Cardiovascular Risk for Patients With HIV and Low HDL

The main lipid abnormality of people living with HIV is low high density lipoprotein (HDL).  There are 5 subfractions of HDL: 2a, 2b, 3a, 3b, and 3c, from largest (and most effective in cholesterol removal) to smallest (and least effective).

Neither pravastatin nor rosuvastatin changes the distribution of high-density lipoprotein (HDL) subfractions in patients who are HIV-seropositive with severe dyslipidaemia undergoing treatment with a combined antiretroviral therapy (cART) and protease inhibitor, according to substudy results presented at the 82nd European Atherosclerosis Society (EAS) Congress.

In their substudy, Dr. Bittar and colleagues set out to determine the distribution of the HDL subfractions in 90% of these patients, both at baseline and following statin treatment.
Thirty-six patients (median age, 49 years; 81% male) were part of the pravastatin group (40 mg/day) and 38 patients (median age, 46 years; 76% male) were part of the rosuvastatin group (10 mg/day), all with 45 days of treatment.
At baseline, the HDL subclass distribution in the pravastatin and rosuvastatin groups was similar, with percentage distributions for HDLs 2a/b/3a/b/c of 27.1%/12.8%/31.7%/20.7%/7.3% and 26.6%/13.8%/31.3%/21.0%/7.1%, respectively.
After the 45 days of statin treatment, these values were unchanged, at 27.5%/12.4%/32.7%/19.9%/7.2% and 27.1%/14.6%/31.7%/19.1%/6.6%, respectively.
For natural ways to improve HDL: 
  1. Get aerobic exercise. Moderate to vigorous aerobic exercise can boost HDL by 5% to 10%. Aim for five 30-minute sessions per week.
  2. Lose weight if you need to. If you’re overweight or obese, you can boost your HDL level by about 1 mg/dL for every seven pounds lost, although any amount of weight loss will help.
  3. If you smoke, quit. HDL levels rise by as much as 15% to 20% after you quit.
  4. Eat a healthy diet. Avoid trans fats, which increase bad cholesterol and decrease good cholesterol. Avoid highly refined carbohydrates, such as white-flour products.
  5. Consider medications. Niacin, available over the counter, is the most effective HDL-raising medication available. Niacin can be strong medicine — work with your clinician if you want to try it.    NAC  is also a good supplement to consider.
  6. Avoid higher doses of testosterone

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