How to increase High-Density Lipoprotein (HDL)?

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. Maintaining 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 is also crucial. Losing excess weight can significantly boost HDL levels, with even a 5-10% reduction in body weight showing benefits 1. 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.

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.
• Medications like niacin (500-2000 mg daily), fibrates (fenofibrate, gemfibrozil), and statins can raise HDL, though they're typically prescribed primarily for lowering LDL 1.
• Omega-3 supplements (1-4 grams daily) may modestly increase HDL 1.

Overall, a combination of lifestyle modifications and, if necessary, medication can help increase HDL cholesterol levels, reducing the risk of heart disease and improving overall health outcomes.

From the FDA Drug Label

Gemfibrozil is a lipid regulating agent which decreases serum triglycerides and very low density lipoprotein (VLDL) cholesterol, and increases high density lipoprotein (HDL) cholesterol Gemfibrozil increases levels of high density lipoprotein (HDL) subfractions HDL2 and HDL3, as well as apolipoproteins AI and AII Physical exercise can be an important ancillary measure, and has been associated with rises in HDL-cholesterol.

To increase High-Density Lipoprotein (HDL), the following can be considered:

• Gemfibrozil therapy: It has been shown to increase HDL-cholesterol significantly in patients with elevated triglycerides due to Type IV hyperlipoproteinemia and in Type IIb patients with elevations of both serum LDL-cholesterol and triglycerides.
• Physical exercise: It can be an important ancillary measure and has been associated with rises in HDL-cholesterol.

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From the Research

Increasing High-Density Lipoprotein (HDL)

To increase HDL levels, several lifestyle interventions and pharmacological approaches can be considered. The following points highlight some of the key methods:

• Lifestyle Interventions:
  • Physical exercise: Regular aerobic exercise has been shown to modestly increase HDL-C levels 3. The minimal weekly exercise volume for increasing HDL-C level is estimated to be 900 kcal of energy expenditure per week or 120 minutes of exercise per week.
  • Weight loss: Caloric restriction or specific dietary approaches can help modify serum HDL cholesterol 4.
  • Smoking cessation: Quitting smoking is recommended as part of lifestyle interventions to improve HDL outcomes 4.
  • Moderate alcohol consumption: Permitted in some cases, but its impact on HDL should be considered in the context of overall health 4.
• Pharmacological Approaches:
  • Niacin: It is the most potent HDL-increasing drug currently available and also lowers triglycerides and LDL cholesterol 5. However, its role in treatment may be limited due to recent findings 6.
  • Fibrates: They may continue to have a role in the treatment of extreme hypertriglyceridaemia and mixed hyperlipidaemia, as they reduce CVD events and have additional benefits in improving diabetes and microvascular outcomes 6.
  • Statins: While primarily used to lower LDL cholesterol, statins also somewhat increase HDL cholesterol 5.
• Dietary Considerations:
  • There is no direct evidence provided in the studies regarding specific dietary components that increase HDL. However, dietary approaches are mentioned as part of lifestyle interventions 4.

Exercise and HDL Functionality

Exercise, particularly regular aerobic exercise, has been identified as a potential therapy to improve HDL function, including its atheroprotective functions such as cholesterol efflux, antioxidative, and anti-inflammatory properties 7. However, the evidence is mixed, and more research is needed to determine the most effective exercise dose and population for improving HDL functionality.