How to increase High-Density Lipoprotein (HDL) cholesterol?

From the Guidelines

To increase HDL (high-density lipoprotein) cholesterol, focus on lifestyle modifications including regular aerobic exercise for at least 30 minutes most days of the week, which stimulates HDL production, as supported by the study published in Sports Medicine in 2014 1. Maintain a healthy diet rich in monounsaturated and polyunsaturated fats found in olive oil, nuts, and fatty fish while limiting trans fats and refined carbohydrates. Losing excess weight can significantly improve HDL levels, as can quitting smoking, which can increase HDL by up to 10% 1. Moderate alcohol consumption (one drink daily for women, up to two for men) may help, but excessive drinking is harmful. Medications like niacin (500-2000 mg daily), fibrates (fenofibrate, gemfibrozil), and statins can raise HDL levels, though they're typically prescribed when lifestyle changes aren't sufficient, as noted in the study published in Diabetes Care in 2004 1. Omega-3 supplements (1-4 grams daily) may provide modest benefits. Some key points to consider:

• Regular physical activity has been shown to increase HDL cholesterol while maintaining, and theoretically offsetting increases in, LDL cholesterol and triglycerides 1.
• A dose–response relationship between activity levels and HDL cholesterol levels has been observed, with more intense activity required to elicit reductions in LDL cholesterol and triglyceride levels 1.
• Aerobic exercise at high intensities appears to be effective in improving the lipid profile, and the effects surpass those of physical activity by initiating clearance of plasma LDL cholesterol and triglycerides 1.
• Resistance training presents a viable alternative to aerobic exercise or is an effective intervention independently, and the addition of resistance training to aerobic exercise will supplement—and possibly enhance—the effects on the lipid profile 1. HDL is important because it removes excess cholesterol from the bloodstream and transports it to the liver for processing, helping to reduce cardiovascular disease risk. Key lifestyle modifications and interventions include:
• Increased physical activity, such as aerobic exercise and resistance training
• Healthy diet with emphasis on monounsaturated and polyunsaturated fats
• Weight loss and smoking cessation
• Moderate alcohol consumption
• Consideration of medications like niacin, fibrates, and statins when necessary
• Potential benefits of omega-3 supplements.

From the FDA Drug Label

The lipid-modifying effects of fenofibric acid seen in clinical practice have been explained in vivo in transgenic mice and in vitro in human hepatocyte cultures by the activation of peroxisome proliferator activated receptor α (PPARα) Through this mechanism, fenofibrate increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III (an inhibitor of lipoprotein lipase activity) The resulting decrease in TG produces an alteration in the size and composition of LDL from small, dense particles (which are thought to be atherogenic due to their susceptibility to oxidation), to large buoyant particles. These larger particles have a greater affinity for cholesterol receptors and are catabolized rapidly Activation of PPARα also induces an increase in the synthesis of apolipoproteins A-I, A-II and HDL-cholesterol.

Increasing HDL can be achieved through the use of fenofibrate, as it activates PPARα, which in turn increases the synthesis of apolipoproteins A-I, A-II, and HDL-cholesterol 2.

• Fenofibrate is indicated as adjunctive therapy to diet to increase high-density lipoprotein cholesterol (HDL-C) in adult patients with primary hypercholesterolemia or mixed dyslipidemia 2.
• The initial dose of fenofibrate tablet is 160 mg once daily for primary hypercholesterolemia or mixed dyslipidemia 2.

From the Research

Increasing HDL Levels

To increase HDL (high-density lipoprotein) levels, several lifestyle interventions and dietary changes can be beneficial. These include:

• A healthful diet that is low in saturated fat and sufficient in unsaturated fat 3
• Regular physical activity 3
• Attaining a healthy weight 3
• Moderate alcohol consumption 3
• Cessation of cigarette smoking 3

Dietary Interventions

Specific dietary interventions that can help increase HDL levels include:

• Consuming omega-3 fatty acids, which have been shown to improve HDL functionality and increase HDL levels 4, 5
• Increasing intake of unsaturated fats, such as those found in nuts, seeds, and avocados 3

Medications

Certain medications, such as niacin, have been shown to increase HDL levels 6, 7. Additionally, omega-3 fatty acid supplements have been found to be effective in improving HDL functionality and reducing cardiovascular risk 4.

Combination Therapies

Combining a healthy diet with weight loss and physical activity can increase HDL levels by 10% to 13% 3. Combination therapies, such as combining niacin with omega-3 fatty acids, may also be beneficial in increasing HDL levels and reducing cardiovascular risk 6, 7.