From the Guidelines
To address declining HDL cholesterol levels, focus on lifestyle modifications including regular aerobic exercise, maintaining a healthy weight, and adopting a Mediterranean-style diet rich in olive oil, nuts, fatty fish, and whole grains, as these changes have been shown to increase HDL cholesterol levels and reduce the risk of coronary heart disease 1.
Key Lifestyle Modifications
- Regular aerobic exercise: aim for at least 30 minutes of moderate-intensity exercise per day
- Healthy weight maintenance: aim for a body mass index (BMI) between 18.5 and 24.9
- Mediterranean-style diet: rich in olive oil, nuts, fatty fish, and whole grains
Additional Recommendations
- Limit trans fats and refined carbohydrates
- Moderate alcohol consumption: one drink daily for women, up to two for men, but only if already consuming alcohol
- Quit smoking if applicable
Medications and Supplements
- Medications like niacin (500-2000mg daily), fibrates (fenofibrate, gemfibrozil), or statins may be prescribed by a doctor if lifestyle changes are not sufficient
- Omega-3 supplements (1-4g daily) may provide modest benefits
Importance of HDL Cholesterol
- HDL cholesterol removes excess cholesterol from tissues and transports it to the liver for elimination, providing cardiovascular protection
Monitoring and Treatment
- Regular monitoring of complete lipid profile is essential to track progress
- Any treatment plan should be developed with a healthcare provider based on overall cardiovascular risk profile 1
From the Research
HDL Decline: Causes and Interventions
- HDL decline is a significant predictor of cardiovascular disease risk, and lifestyle interventions such as physical exercise, weight loss, and smoking cessation can help modify serum HDL cholesterol levels 2.
- Regular exercise has been shown to improve HDL function, including cholesterol efflux, antioxidative, and anti-inflammatory properties, although the evidence is mixed and more studies are needed to determine the optimal exercise dose 3.
Therapeutic Strategies
- Increasing HDL quantity and function is a complex therapeutic target, but new strategies are being developed to promote reverse cholesterol transport and improve HDL function 4.
- Simply increasing HDL-cholesterol concentration without improving function or decreasing triglyceride-rich lipoproteins may not be beneficial for atherosclerosis prevention 5.
- Raising HDL-C levels has been shown to reduce cardiovascular disease risk, but established drug therapies resulting in substantial HDL-C increase are scarce and their effect is controversial 6.
Importance of HDL Functionality
- HDL particle functionality is at least as important as HDL-C levels, as HDL particles promote reverse cholesterol transport and exert pleiotropic effects on inflammation, haemostasis, and apoptosis 6.
- Therapeutic strategies should aim to improve HDL function, rather than just increasing HDL-cholesterol concentration, to reduce the risk of cardiovascular disease 5.