By Richard Harkness
Enquirer contributor

Question: I'm 58, split firewood with a mallet, ride a bike, walk, and carry my bag while playing golf. I take the cholesterol-lowering drug Lipitor along with vitamin E, vitamin C, beta-carotene and an aspirin every day. The problem is that my good cholesterol (HDL) is low and my bad cholesterol (LDL) is high. Should I:

1. Keep taking Lipitor and forget vitamin E?

2. Forget Lipitor and take vitamin E?

3. Take Lipitor and forget all the others?

4. Increase the amount of chocolate I eat and feel happy?

Answer: I like your humorous outlook (and active lifestyle), but go a little easy on the chocolate portion of option number 4. As for your multiple choice quiz, I'd add the following option and check it: 5. None of the above (explanation follows).

Your main concern seems to be whether your vitamin E supplement might interfere with the effect of Lipitor. I've received similar questions since the media reported that vitamin E might impair the expected ability of cholesterol-controlling drugs to raise levels of HDL cholesterol (the good kind). Actually, the clinical study in question implicated a group of antioxidants, which included vitamin E. The effect was modest, and there was no way to single out the role of vitamin E.

Vitamin E supplements show promise in Alzheimer's disease, cancer, arthritis and a number of other conditions, so it seems unwarranted to give up your vitamin E unless your physician advises otherwise.

One thing I might question is your use of beta-carotene supplementation, which research suggests may actually increase the risk of heart disease (in smokers) and lung cancer (in smokers and asbestos workers). Since beta-carotene needs are easily met by eating fruits and vegetables, it seems best to get it this way. The nutritional doses present in typical multivitamin supplements should be safe.

A diet low in saturated fats and cholesterol will lower LDL cholesterol (the bad kind). Adding soluble fiber (e.g., barley oats, soy, psyllium) and plant stanol/sterol-containing margarines (e.g., Benecol, Take Control) enhances this effect.

Typically, you should keep your LDL cholesterol below 130 if you're at moderate risk for cardiovascular complications, or below 100 if you already have heart disease or diabetes. If dietary changes aren't enough, your physician may adjust the dose of your Lipitor or add a second cholesterol-lowering agent.

You want as much HDL cholesterol as possible because it helps the body round up and remove rampant cholesterol.

The first step in boosting HDL cholesterol levels is to increase physical activity and lose weight (if overweight).

A number of other factors can push down HDL cholesterol, including high triglycerides, smoking, very high carbohydrate intake (this also raises triglycerides), drugs (e.g., anabolic steroids, beta-blockers, progestins, loop diuretics, phenothiazines) and medical conditions (e.g., hyperthyroidism, diabetes, high blood pressure, cholestasis, nephrotic syndrome, chronic renal failure).

Lipitor has only a modest effect on HDL cholesterol, so if your levels stubbornly remain low (below 40), your physician might consider adding a drug that increases HDL cholesterol, such as niacin or a fibrate (e.g., gemfibrozil, fenofibrate).

E-mail rharkn@aol.com