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

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, avocados, nuts, and fatty fish while limiting trans fats and refined carbohydrates. Losing excess weight can significantly boost HDL levels, with even a 5-10% reduction in body weight showing benefits. Quitting smoking can improve HDL levels within weeks, 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 like niacin (500-2000 mg daily), fibrates (fenofibrate, gemfibrozil), and statins can raise HDL, though they're typically prescribed primarily for lowering LDL, as noted in the guidelines for managing patients with chronic stable angina 1. Omega-3 supplements (1-4 grams daily) may modestly increase HDL. 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.
• 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.
• 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 protect against heart disease. It's also important to consider the guidelines for managing dyslipidemia in adults with diabetes, which recommend lifestyle interventions, including weight loss and increased physical activity, as the first line of treatment, with medications such as statins, fibrates, and niacin considered for those who do not achieve lipid goals with lifestyle modifications 1.

From the FDA Drug Label

Fenofibrate also reduces serum uric acid levels in hyperuricemic and normal individuals by increasing the urinary excretion of uric acid. Activation of PPARα also induces an increase in the synthesis of apolipoproteins A-I, A-II and HDL-cholesterol. In addition, treatment with fenofibrate results in increases in high density lipoprotein (HDL) and apolipoproteins apo AI and apo AII. 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.

Increasing HDL can be achieved by:

• Using fenofibrate as adjunctive therapy to diet 2
• Activating PPARα to induce an increase in the synthesis of apolipoproteins A-I, A-II and HDL-cholesterol 2 Key points:
• Fenofibrate increases HDL-cholesterol 2
• Fenofibrate is indicated to increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia 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.