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, as supported by the study 1 that reported a mean increase in HDL cholesterol of 4.6% with physical activity interventions.
Key Lifestyle Modifications
- Maintain a heart-healthy diet rich in monounsaturated and polyunsaturated fats found in olive oil, nuts, avocados, and fatty fish, as recommended by the American Heart Association 1, while limiting saturated and trans fats.
- Losing excess weight can significantly improve HDL levels, with even a 5-10% reduction in body weight showing benefits.
- 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 slightly increase HDL, though this isn't recommended as a strategy for non-drinkers.
Medications
Medications like niacin (500-2000mg daily), fibrates (fenofibrate, gemfibrozil), and statins can also raise HDL levels, though their primary benefit is lowering LDL, as noted in the guidelines 1 and 1.
Importance of HDL
HDL is important because it acts as a "good" cholesterol that removes harmful LDL cholesterol from the bloodstream and transports it to the liver for processing and elimination, reducing cardiovascular risk.
Additional Considerations
- The mechanisms underlying the effect of exercise on the lipid profile are unclear, but exercise appears to enhance the ability of skeletal muscles to utilize lipids as opposed to glycogen, thus reducing plasma lipid levels 1.
- Foods rich in v-3 polyunsaturated fatty acids, specifically EPA and DHA, confer cardioprotective effects beyond those that can be ascribed to improvements in blood lipoprotein profiles, as reported by the American Heart Association 1.
From the FDA Drug Label
The lipid-modifying effects of fenofibric acid seen in clinical practice have been explained in vivo in transgenic mice and in vitro in human hepatocyte cultures by the activation of peroxisome proliferator activated receptor α (PPARα) Through this mechanism, fenofibrate increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III (an inhibitor of lipoprotein lipase activity) The resulting decrease in TG produces an alteration in the size and composition of LDL from small, dense particles (which are thought to be atherogenic due to their susceptibility to oxidation), to large buoyant particles. These larger particles have a greater affinity for cholesterol receptors and are catabolized rapidly Activation of PPARα also induces an increase in the synthesis of apolipoproteins A-I, A-II and HDL-cholesterol. Fenofibric acid, the active metabolite of fenofibrate, produces reductions in total cholesterol, LDL cholesterol, apolipoprotein B, total triglycerides and triglyceride rich lipoprotein (VLDL) in treated patients. In addition, treatment with fenofibrate results in increases in high density lipoprotein (HDL) and apolipoproteins apo AI and apo AII. 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.
Increasing High-Density Lipoprotein (HDL) can be achieved by:
- Using fenofibrate as adjunctive therapy to diet in adult patients with primary hypercholesterolemia or mixed dyslipidemia 2
- Activating peroxisome proliferator activated receptor α (PPARα) which induces an increase in the synthesis of apolipoproteins A-I, A-II and HDL-cholesterol 2
- Reducing triglycerides (TG) and increasing the size and composition of LDL particles, which can lead to an increase in HDL 2
From the Research
Increasing High-Density Lipoprotein (HDL) Levels
To increase HDL levels, several lifestyle interventions and pharmacological means can be employed. The following methods have been identified as beneficial:
- A healthful diet that is low in saturated fat and sufficient in unsaturated fat, as well as regular physical activity, attaining a healthy weight, moderate alcohol consumption, and cessation of cigarette smoking 3
- Combining a healthy diet with weight loss and physical activity can increase HDL-C by 10% to 13% 3
- Physical activity and exercise training increase HDL-C levels, especially HDL2-C levels, by multiple mechanisms 4
- Aerobic exercise is believed to reduce the risk of cardiovascular disease partially through increasing serum levels of HDL-C, with a minimal weekly exercise volume for increasing HDL-C level estimated to be 900 kcal of energy expenditure per week or 120 minutes of exercise per week 5
- Exercise duration per session was found to be the most important element of an exercise prescription, with every 10-minute prolongation of exercise per session associated with an approximately 1.4-mg/dL increase in HDL-C level 5
Pharmacological Interventions
In addition to lifestyle changes, several pharmacological means can be used to increase HDL levels, including:
- Inhibitors of cholesteryl ester transfer protein (CETP) which substantially increase HDL-C levels (by 31-138%) 4
- Niacin, fibrates, thiazolidinediones, apolipoprotein A1 mimetics, and statins, such as pitavastatin and rosuvastatin, which consistently elicit marked increases in HDL-C 6
- Reconstituted HDL or apolipoprotein A-I mimetic peptides which increase the functionality of HDL 4
HDL Functionality
Research has also focused on identifying therapies that improve HDL function, with exercise representing a potential therapy 7. The effects of exercise on HDL functionality include: