How to increase High-Density Lipoprotein (HDL) levels?

How to Increase HDL Cholesterol Levels

Regular physical activity is the most effective lifestyle intervention for increasing HDL cholesterol levels, with at least 30 minutes of moderate-intensity aerobic exercise 5 times weekly recommended as the foundation of any HDL-raising strategy. 1

Exercise Recommendations

• Perform prolonged moderate-intensity aerobic exercise at 70-80% heart rate reserve, combined with low-intensity resistance training at 50% of 1 repetition maximum (1RM) for healthy individuals 2
• For those with dyslipidemia, progress to 85% maximum heart rate with moderate to high-intensity resistance training at 75-85% 1RM 2
• A linear dose-response relationship exists between activity levels and HDL cholesterol increases - more exercise generally yields greater HDL improvements 2, 1
• For individuals with limited mobility, incorporate resistance training progressing from 50% to 75% 1RM in major muscle groups into circuit sessions 2
• The combination of aerobic exercise and resistance training provides enhanced benefits for the overall lipid profile compared to either modality alone 1, 3

Dietary Modifications

• Replace saturated fats with monounsaturated fats (such as olive oil) or polyunsaturated fats rather than with carbohydrates to maintain HDL levels 2, 4
• Limit refined carbohydrates and sugars, as high-carbohydrate diets can reduce HDL cholesterol levels 2, 4
• Avoid trans-unsaturated fatty acids, which can lower HDL cholesterol 1, 5
• Consume a diet rich in vegetables, fruits, and whole grains with high fiber content 4

Weight Management

• Achieve and maintain a healthy body weight through caloric control, as excess weight adversely affects HDL cholesterol levels 2, 4
• Weight reduction is particularly important for those with the combination of elevated triglycerides and low HDL cholesterol 2
• Combining a healthy diet with weight loss and physical activity can increase HDL-C by 10% to 13% 5

Other Lifestyle Modifications

• Quit smoking, as smoking cessation can increase HDL cholesterol levels by up to 30% 1, 6
• If alcohol is consumed, do so in moderation (excessive alcohol can aggravate hypertriglyceridemia) 2

Pharmacological Options

• Niacin (nicotinic acid) is the most effective medication for raising HDL cholesterol, but can affect blood glucose levels 1, 4
• Fibrates like gemfibrozil can effectively increase HDL cholesterol levels and reduce triglycerides 7
• Statins primarily target LDL cholesterol but may also modestly increase HDL levels by approximately 5% 8

Monitoring Progress

• Measure lipid levels annually in adults with risk factors; if values are at low-risk levels, assessment may be repeated every 2 years 2
• Evaluate lifestyle intervention effectiveness at regular intervals, with consideration of pharmacological therapy between 3-6 months if targets are not achieved 2

Common Pitfalls to Avoid

• Very low-fat diets (<15% energy as fat) can paradoxically lower HDL cholesterol 4
• High-carbohydrate diets, especially those high in sugars, may reduce HDL cholesterol levels 2, 4
• Relying solely on medication without addressing underlying lifestyle factors will limit long-term success 4

Remember that while increasing HDL cholesterol is beneficial, a comprehensive approach to cardiovascular risk reduction should also address other lipid parameters and risk factors.