How can I increase my High-Density Lipoprotein (HDL) and decrease my Low-Density Lipoprotein (LDL)?

From the Guidelines

To improve your cholesterol profile by increasing HDL (good cholesterol) and decreasing LDL (bad cholesterol), focus on lifestyle modifications and possibly medication if needed, as recommended by the most recent and highest quality study 1. Regular aerobic exercise of at least 30 minutes most days of the week can raise HDL levels by 5-10% and lower LDL levels. Adopting a heart-healthy diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids from fish like salmon and mackerel, while limiting saturated fats, trans fats, and refined carbohydrates, can also help improve cholesterol levels. Losing weight if overweight can lower LDL by 5-8% for every 10 pounds lost, as noted in 1. Quitting smoking can increase HDL by up to 10% within a year. Moderate alcohol consumption (one drink daily for women, up to two for men) may raise HDL slightly, but isn't recommended as a strategy if you don't already drink. For medication, statins like atorvastatin or rosuvastatin are first-line treatments that can lower LDL by 20-60%, while fibrates, niacin, or omega-3 supplements may help raise HDL, as discussed in 1 and 1. These lifestyle changes work by reducing inflammation, improving liver function in cholesterol processing, and enhancing the body's natural cholesterol transport system, which removes excess cholesterol from the bloodstream. Some key points to consider include:

• Regular physical activity has been shown to increase HDL cholesterol while maintaining, and theoretically offsetting increases in, LDL cholesterol and triglycerides, as seen in 1 and 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.
• The dose–response relationship between the lipid profile and energy expenditure seems to transcend the mode of exercise, as noted in 1. Overall, a combination of lifestyle modifications and medication, if necessary, can help improve your cholesterol profile and reduce the risk of heart disease, as supported by the evidence from 1, 1, 1, 1, 1, and 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Gemfibrozil is a lipid regulating agent which decreases serum triglycerides and very low density lipoprotein (VLDL) cholesterol, and increases high density lipoprotein (HDL) cholesterol While modest decreases in total and low density lipoprotein (LDL) cholesterol may be observed with gemfibrozil therapy, treatment of patients with elevated triglycerides due to Type IV hyperlipoproteinemia often results in a rise in LDL-cholesterol LDL-cholesterol levels in Type IIb patients with elevations of both serum LDL-cholesterol and triglycerides are, in general, minimally affected by gemfibrozil treatment; however, gemfibrozil usually raises HDL-cholesterol significantly in this group.

To increase your HDL and decrease your LDL, consider the following:

• Gemfibrozil therapy may help increase HDL cholesterol and decrease triglycerides and VLDL cholesterol.
• However, gemfibrozil may not significantly decrease LDL cholesterol in all patients, and may even increase it in some cases.
• Alirocumab is another option that can help reduce LDL-C levels, but its effect on HDL is not directly stated in the provided drug label.
• It is essential to consult a healthcare professional to determine the best course of treatment for your specific condition 2.

From the Research

Increasing HDL and Decreasing LDL

To increase High-Density Lipoprotein (HDL) and decrease Low-Density Lipoprotein (LDL), several strategies can be employed:

• Medications: Statins, fibrates, and niacin are effective in lowering LDL and increasing HDL levels 3, 4. Statins inhibit the de-novo synthesis of cholesterol, reducing LDL cholesterol and increasing HDL cholesterol. Fibrates and niacin also lower triglycerides and increase HDL cholesterol.
• Lifestyle Approaches: Dietary factors and lifestyle practices can significantly affect LDL, HDL, and triglyceride levels, consequently decreasing coronary heart disease risk 5. A healthy diet and regular exercise can help increase HDL and decrease LDL levels.
• Combination Therapies: Combination therapies, such as rosuvastatin with fenofibrate or omega-3 fatty acids, can effectively reduce LDL cholesterol and triglyceride levels 6. However, the effect on HDL levels may vary depending on the specific combination.
• Specific Treatments: Atorvastatin and fenofibrate have different effects on nonlipid biochemical risk factors and LDL particle size in subjects with combined hyperlipidemia 7. Atorvastatin is more efficient in reducing total cholesterol and LDL cholesterol, while fenofibrate is more efficient in reducing triglycerides and increasing HDL cholesterol.

Key Considerations

When aiming to increase HDL and decrease LDL, it is essential to consider the following:

• Individual Risk Profile: The selection of a particular lipid-lowering modality should be based on the patient's risk profile 7.
• Combination Therapy: Combination therapies can be effective, but the specific combination and its effects on HDL and LDL levels should be carefully considered 6.
• Lifestyle Modifications: Lifestyle approaches, including dietary changes and regular exercise, can significantly impact HDL and LDL levels 5.