The Garbage Trucks in Your Blood

2. Niacin. In small doses, niacin is a vitamin. In large doses, it becomes a cholesterol-lowering drug. It raises HDL somewhat (not as much as torcetrapib) and lowers LDL.

Niacin is available in nonprescription forms. Most doctors recommend starting with relatively small doses of 100 mg three times per day and working up to 500 mg three times per day or even higher doses. Niacin is also available as a prolonged-release prescription drug, Niaspan, which has two advantages: you only have to take it once a day, and the potency of the drug is more well-standardized than those available over-the-counter.

Niacin may cause liver damage, so it's important for your doctor to do blood tests to make sure that your liver is OK, especially at higher doses. Also, niacin may cause flushing and itching. Fortunately, these side effects tend to get better over time, especially if the dose of niacin is increased slowly over time. Taking it with food and with aspirin may also reduce some of these side effects.

Two years ago, Dr. Allen Taylor of the Walter Reed Army Medical Center reported niacin plus statin drugs kept blockages in heart arteries from getting worse. There were fewer heart attacks, strokes and deaths in those taking niacin plus statins than in those taking statins alone. Dr. Greg Brown of the University of Washington is conducting a large multicenter study comparing the effects of niacin plus a statin drug (Zocor) with Zocor alone.

3. Exercise. Regular aerobic exercise will raise HDL levels. In some people, this may be significant, but in most people it only raises HDL about 5 percent.

4. Alcohol. Moderate intake of alcohol (no more than one to two drinks per day) may raise your HDL level. One drink is usually considered to be 12 ounces of beer, 4 ounces of wine, or 1½ ounces of spirits (hard liquor). However, some studies suggest that alcohol may raise a subfraction of HDL that is not related to the risk of coronary heart disease, but others show that it does.