How to manage low High-Density Lipoprotein (HDL) cholesterol?

From the Guidelines

To manage low HDL cholesterol, focus on lifestyle modifications and consider medications that can help raise HDL levels, as the most recent and highest quality study 1 emphasizes the importance of lifestyle changes and selective use of medications like niacin, fibrates, and statins. When managing low HDL cholesterol, it's essential to prioritize lifestyle modifications, including:

• Regular aerobic exercise (aim for at least 30 minutes most days)
• Maintaining a healthy weight
• Adopting a heart-healthy diet rich in omega-3 fatty acids, fiber, and monounsaturated fats
• Quitting smoking and limiting alcohol to moderate consumption (one drink daily for women, up to two for men) Medications that can help raise HDL include:
• Niacin (starting at 500mg daily, gradually increasing to 1-2g daily, taken with meals to reduce flushing)
• Fibrates like fenofibrate (145mg daily) or gemfibrozil (600mg twice daily)
• Statins, which primarily lower LDL but may modestly increase HDL
• Omega-3 supplements (1-4g daily) may also help Regular monitoring of your lipid profile every 3-6 months is important to assess progress, as recommended by 1. These approaches work by various mechanisms - exercise stimulates enzymes that increase HDL production, dietary changes reduce inflammation and improve cholesterol transport, while medications like niacin decrease the breakdown of HDL and enhance its production. Remember that raising HDL is just one part of overall cardiovascular risk reduction, so addressing other risk factors like high blood pressure and diabetes is equally important, as emphasized by 1 and 1.

From the FDA Drug Label

The magnitude of individual lipid and lipoprotein responses may be influenced by the severity and type of underlying lipid abnormality. Nicotinic acid (but not nicotinamide) in gram doses produces an average 10% to 20% reduction in total and LDL cholesterol, a 30% to 70% reduction in triglycerides, and an average 20% to 35% increase in HDL cholesterol. Fenofibrate tablets therapy also lowered triglycerides and raised HDL-C.

To manage low High-Density Lipoprotein (HDL) cholesterol, consider the following:

• Nicotinic acid may be used to increase HDL cholesterol, with an average increase of 20% to 35%.
• Fenofibrate may also be used to raise HDL-C, with a mean percent change of +11.0% in HDL-C. Key points to consider:
• The magnitude of individual lipid and lipoprotein responses may be influenced by the severity and type of underlying lipid abnormality.
• It is essential to consult the FDA drug label for specific dosing and administration instructions for nicotinic acid and fenofibrate 2 3.

From the Research

Managing Low High-Density Lipoprotein (HDL) Cholesterol

To manage low HDL cholesterol, several strategies can be employed, including lifestyle interventions and pharmacologic options.

• Lifestyle interventions that can help increase HDL-C levels include:
  • A healthful diet that is low in saturated fat and sufficient in unsaturated fat 4
  • Regular physical activity 4
  • Attaining a healthy weight 4
  • Moderate alcohol consumption 4
  • Cessation of cigarette smoking 4
• Combining a healthy diet with weight loss and physical activity can increase HDL-C by 10% to 13% 4
• Pharmacologic options for managing low HDL levels include:
  • Niacin 5, 6
  • Fibrates 5, 6
  • Statins 5, 6
  • Emerging therapies such as beta-glucans, Apo-A1 mimetic peptides, and ACAT inhibitors 5
  • HDL mimetics, such as apolipoprotein A-I mimetic peptides, which improve the functional properties of HDL cholesterol 7

Importance of Managing Low HDL Cholesterol

Low HDL cholesterol is associated with an increased risk of cardiovascular disease, including myocardial infarction, stroke, and peripheral artery disease 5, 8.

• Epidemiologic studies have shown an inverse relation between HDL cholesterol levels and cardiovascular risk 5
• Each 1-mg increase in HDL levels decreases the risk of cardiovascular disease by 2% to 3% 5
• Managing low HDL cholesterol is crucial for reducing the risk of cardiovascular disease, especially in patients with high risk factors 8, 6