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

From the Guidelines

To increase HDL, regular aerobic exercise, such as prolonged moderate-intensity aerobic exercise, should be recommended as a starting point, as it has been shown to increase HDL cholesterol levels 1.

Importance of Exercise

The relationship between physical activity and HDL levels is well-established, 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.
• The dose–response relationship between the lipid profile and energy expenditure seems to transcend the mode of exercise.

Additional Recommendations

In addition to exercise, other lifestyle modifications can help increase HDL levels, including:

• Maintaining 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, with even a 5-10% reduction in body weight showing benefits.
• Quitting smoking, as smoking depletes HDL.
• Moderate alcohol consumption (one drink daily for women, up to two for men) may increase HDL, though this isn't recommended as a strategy for non-drinkers.

Medications and Supplements

Medications like niacin (500-2000 mg daily), fibrates (fenofibrate, gemfibrozil), and statins can raise HDL, though they're typically prescribed primarily for lowering LDL 1.

• Omega-3 supplements (1-4 grams daily) may modestly increase HDL.

Clinical Considerations

It's essential to consider the baseline condition of patients and encourage as much physical activity as possible, highlighting the additional impact or appropriateness of aerobic exercise, resistance training, or both to obtain optimal benefits 1.

• A low HDL level should receive clinical attention and management according to the sequence outlined in the ATP III guidelines 1.

From the FDA Drug Label

Fenofibrate tablets are indicated as adjunctive therapy to diet to reduce elevated low-density lipoprotein cholesterol (LDL-C), total cholesterol (Total-C), Triglycerides and apolipoprotein B (Apo B), and to increase high-density lipoprotein cholesterol (HDL-C) in adult patients with primary hypercholesterolemia or mixed dyslipidemia. The active moiety of fenofibrate tablet is fenofibric acid... Through this mechanism, fenofibrate increases lipolysis and elimination of triglyceride-rich particles from plasma... Activation of PPARα also induces an increase in the synthesis of apolipoproteins A-I, A-II and HDL-cholesterol.

Increasing HDL can be achieved by using fenofibrate as an adjunctive therapy to diet. The medication works by activating peroxisome proliferator activated receptor α (PPARα), which increases the synthesis of apolipoproteins A-I, A-II, and HDL-cholesterol. Key points to consider:

• Dietary therapy is the initial treatment for dyslipidemia
• Fenofibrate should be given with meals to optimize bioavailability
• Lipid levels should be monitored periodically to adjust the dosage as needed 2

From the Research

Increasing HDL Levels

To increase HDL levels, several lifestyle interventions can be implemented, including:

• Regular aerobic exercise, which has been shown to improve HDL function and increase HDL-C levels 3, 4, 5, 6
• A healthful diet that is low in saturated fat and sufficient in unsaturated fat, which can increase HDL-C levels when combined with weight loss and physical activity 7
• Attaining a healthy weight, which can also contribute to increased HDL-C levels 7
• Moderate alcohol consumption and cessation of cigarette smoking, which can also have a beneficial effect on HDL-C levels 7

Exercise and HDL

Exercise has been shown to have a beneficial effect on HDL levels and function, including:

• Improving cholesterol efflux capacity, although the evidence is mixed and may depend on the dose and intensity of exercise 3, 6
• Enhancing the antioxidative and anti-inflammatory properties of HDL 3
• Increasing HDL-C levels, particularly when combined with weight loss 4, 5
• Improving HDL particle maturation, composition, and functionality 5, 6

Lifestyle Interventions

Combining a healthy diet with weight loss and physical activity can increase HDL-C levels by 10% to 13% 7, and when combined with interventions that beneficially affect other cardiovascular disease risk factors, this increase in HDL-C is expected to contribute to an overall reduction in cardiovascular disease risk.