From the Guidelines
To treat low HDL cholesterol, the primary approach should focus on lifestyle modifications, including regular aerobic exercise, maintaining a healthy weight, quitting smoking, and adopting a heart-healthy diet, as these changes can help raise HDL levels and improve overall cardiovascular health. According to 1, lifestyle intervention, including medical nutrition therapy, increased physical activity, weight loss, and smoking cessation, may allow some patients to reach lipid goals, and glycemic control can also beneficially modify plasma lipid levels.
When considering pharmacological treatment, niacin is the most effective drug for raising HDL cholesterol, as noted in 1, and can be used especially if a patient is intolerant to statins, with a recommended dose starting at 500mg daily, gradually increasing to 1500-2000mg daily, taken with aspirin to reduce flushing. Fibrates like fenofibrate or gemfibrozil, and statins, though these primarily lower LDL, may also be considered for increasing HDL levels.
It's essential to address low HDL as part of overall cardiovascular risk management, as HDL helps remove excess cholesterol from the bloodstream and provides anti-inflammatory and antioxidant benefits that protect against heart disease. The management approach should follow the sequence outlined in 1 and 1, where the primary target of therapy is LDL cholesterol, and after achieving the LDL goal, emphasis shifts to other issues, including raising HDL levels if they are low.
Key lifestyle modifications and pharmacological treatments include:
- Regular aerobic exercise
- Maintaining a healthy weight
- Quitting smoking
- Adopting a heart-healthy diet rich in omega-3 fatty acids, monounsaturated fats, and fiber
- Moderate alcohol consumption
- Niacin
- Fibrates like fenofibrate or gemfibrozil
- Statins, for their primary effect on lowering LDL but also for their modest effect on raising HDL.
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.
Treatment for low HDL involves using fenofibrate tablets as an adjunct to diet to increase HDL-C levels in adult patients with primary hypercholesterolemia or mixed dyslipidemia 2.
- The initial dose is 160 mg once daily for primary hypercholesterolemia or mixed dyslipidemia.
- Dietary therapy is the initial treatment for dyslipidemia, and patients should be placed on an appropriate lipid-lowering diet before receiving fenofibrate tablets.
From the Research
Treatment of Low HDL Cholesterol
To treat low High-Density Lipoprotein (HDL) cholesterol, several options are available. These include:
- Statins: While primarily used to lower low-density lipoprotein (LDL) cholesterol, statins can also increase HDL cholesterol levels 3.
- Fibrates: These can be used to increase HDL cholesterol levels, especially in patients with high triglyceride levels 4, 5.
- Niacin: Extended-release niacin can increase HDL cholesterol levels and has been shown to have beneficial effects on apolipoproteins 6.
- Omega-3 fatty acids: These have been shown to have beneficial effects on lipid profiles, including increasing HDL cholesterol levels 7, 6.
- Combination therapy: Using a combination of these treatments, such as statins and omega-3 fatty acids or fenofibrate and ezetimibe, may be more effective in improving lipid profiles and increasing HDL cholesterol levels 7, 4.
Benefits and Risks of Treatment
The benefits and risks of these treatments should be carefully considered. For example:
- Statins are generally well-tolerated but can have side effects such as muscle pain and liver damage 3.
- Fibrates can increase the risk of liver damage and gallstones 4, 5.
- Niacin can cause skin flushing and liver damage 6.
- Omega-3 fatty acids are generally well-tolerated but can cause gastrointestinal side effects 7, 6.
- Combination therapy may increase the risk of side effects and interactions between medications 7, 4.