From the Guidelines
Having high levels of High-Density Lipoprotein (HDL) cholesterol is generally considered beneficial for cardiovascular health, and no specific treatment is needed to reduce high HDL levels, as elevated HDL is associated with lower cardiovascular risk. The relationship between HDL cholesterol and cardiovascular health is well-established, with high levels of HDL cholesterol indicating a healthy cardiovascular system 1. HDL cholesterol plays a crucial role in reverse cholesterol transport, helping to remove excess cholesterol from peripheral tissues and transport it to the liver for elimination, which helps prevent cholesterol accumulation in arteries and reduces atherosclerosis risk.
Some key points to consider when evaluating the implications of high HDL cholesterol levels include:
- The concentration of HDL cholesterol is inversely associated with cardiovascular disease (CVD) risk, and determinants of high HDL cholesterol levels include a healthy diet and regular physical activity 1
- High HDL-P reflects efficient reverse cholesterol transport, which is beneficial for cardiovascular health
- Unlike high LDL particles, which require intervention, high HDL-P does not require specific treatment to reduce its levels
- Extremely high HDL levels (above 100 mg/dL) might occasionally warrant further investigation to rule out certain genetic conditions, but high HDL-P itself typically represents a positive finding during lipid assessment and contributes to overall cardiovascular protection
In terms of lifestyle habits that may contribute to high HDL cholesterol levels, the following are recommended:
- Regular physical activity
- Consuming a diet rich in healthy fats (olive oil, fatty fish, nuts)
- Moderate alcohol consumption
- Avoiding smoking
- Maintaining a healthy weight
Overall, having high levels of HDL cholesterol is a positive finding, and individuals with high HDL cholesterol levels should focus on maintaining their current healthy lifestyle habits to continue to support their cardiovascular health 1.
From the Research
Implications of High HDL Cholesterol Levels
- High levels of High-Density Lipoprotein (HDL) cholesterol have been associated with a lower risk of cardiovascular disease in individuals without diabetes 2.
- However, in individuals with diabetes, high HDL cholesterol levels may not provide the same protective effects and may even be associated with an increased risk of coronary heart disease (CHD) 2.
- The functionality of HDL, rather than just its cholesterol level, may be a better indicator of its antiatherogenic capacity 3, 4.
- Lifestyle interventions such as a healthy diet, regular physical activity, and moderate alcohol consumption can increase HDL cholesterol levels and improve its functionality 5, 4.
Effects of Lifestyle Interventions on HDL
- A healthful diet that is low in saturated fat and sufficient in unsaturated fat can increase HDL cholesterol levels by 10-13% when combined with weight loss and physical activity 5.
- Regular physical activity and maintaining a healthy weight have been associated with higher HDL phospholipid and larger HDL particle size 3.
- Moderate alcohol consumption has been shown to improve HDL function, particularly in subjects with cardiovascular risk factors 4.
HDL Particle Subclasses and Cardiovascular Risk
- Smaller HDL particle subclasses have been associated with a higher risk of cardiovascular disease, while larger HDL particle subclasses have been associated with a lower risk 6, 2.
- The level of medium-sized HDL particles (M-HDL-P) has been shown to increase with PCSK9 inhibitor treatment, which may result in a more atheroprotective HDL particle profile 6.
- Very high HDL cholesterol levels have been associated with lower CHD risks in nondiabetics, but higher risks in diabetics, highlighting the importance of considering diabetes status when evaluating the implications of high HDL cholesterol levels 2.