From the Guidelines
HDL cholesterol is crucial for removing excess cholesterol from the bloodstream, and higher levels are associated with a lower risk of heart disease, with regular physical activity, such as at least 30 minutes of moderate exercise most days, being a key factor in increasing HDL levels 1. To increase HDL levels, it is essential to focus on lifestyle modifications, including:
- Regular physical activity, aiming for at least 30 minutes of moderate exercise most days
- Maintaining a healthy weight
- Eating a diet rich in healthy fats like those found in olive oil, nuts, and fatty fish
- Avoiding trans fats and limiting saturated fats
- Quitting smoking, which can increase HDL levels by up to 10%
- Moderate alcohol consumption, although this is not recommended as a strategy if you don't already drink Some studies have shown that physical activity can improve HDL cholesterol levels, with a mean increase of 4.6% reported in one review of 51 papers describing physical activity interventions 1. For some people with persistently low HDL despite lifestyle changes, medications like niacin, fibrates, or statins might be considered, although these are primarily prescribed for other lipid abnormalities 1. It is essential to note that HDL cholesterol plays a critical role in risk estimation, and its levels can contribute substantially to risk estimation if entered as an independent variable, particularly at levels of risk just below the threshold for intensive risk modification of 5% 1.
From the Research
HDL Cholesterol
- HDL cholesterol is considered "good" cholesterol because it helps remove other forms of cholesterol from the bloodstream, reducing the risk of cardiovascular disease 2, 3.
- Low levels of HDL cholesterol are associated with an increased risk of cardiovascular disease, and raising HDL cholesterol levels can help reduce this risk 4, 5.
- Regular exercise has been shown to improve HDL function, including its ability to remove cholesterol from the bloodstream and exert anti-inflammatory effects 4.
Therapies for Raising HDL Cholesterol
- Several therapies are available to raise HDL cholesterol levels, including statins, fibrates, niacin, and omega-3 fatty acids 2, 6, 5.
- Niacin is the most potent HDL-increasing drug currently available, and it also lowers triglycerides and LDL cholesterol 6.
- Fibric acid derivatives are recommended as the first choice for patients with low HDL cholesterol levels and ischemic heart disease or its equivalents, even if the therapeutic target for LDL cholesterol has been achieved 5.
Importance of HDL Cholesterol in Cardiovascular Risk Prevention
- HDL cholesterol levels are an important factor in cardiovascular risk prevention, and serum HDL-C levels should be considered a therapeutic target in both primary and secondary prevention 3, 5.
- A serum HDL-C level of >40 mg/dL should be a therapeutic target in primary and secondary prevention, particularly in patients with low serum HDL-C levels and high cardiovascular risk 5.