How can I increase my High-Density Lipoprotein (HDL) levels?

Effective Strategies to Increase HDL Cholesterol Levels

Regular aerobic exercise is the most effective lifestyle intervention for increasing HDL cholesterol levels, with a recommended minimum of 30 minutes of moderate-intensity activity 5 times weekly. 1, 2

Exercise Recommendations

• Engage in 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, 1
• A combination of aerobic exercise and resistance training provides enhanced benefits for the overall lipid profile compared to either modality alone 1, 3
• There is a linear dose-response relationship between activity levels and HDL cholesterol levels - more activity generally yields greater HDL increases 2, 1
• Aerobic physical activity corresponding to a total energy expenditure of 1500-2200 kcal/week (equivalent to 25-30 km of brisk walking per week) may increase HDL-C levels by 0.08-0.15 mmol/L (3.1-6 mg/dL) 2
• For individuals with limited mobility, resistance training progressing from 50% to 75% 1RM in major muscle groups can be incorporated into circuit sessions 2

Dietary Modifications

• Avoid trans-unsaturated fatty acids, which reduce HDL-C levels 1, 4
• 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 1, 4
• Moderate alcohol consumption (up to 20-30 g/day in men and 10-20 g/day in women) is associated with increased HDL-C levels compared to abstainers 2
• Consume a diet rich in vegetables, fruits, and whole grains with high fiber content 4

Weight Management

• Weight reduction has a beneficial influence on HDL-C levels: a 0.01 mmol/L (0.4 mg/dL) increase is observed for every kg decrease in body weight when weight reduction has stabilized 2
• Achieving and maintaining a healthy weight through caloric control is particularly important for those with elevated triglycerides and low HDL cholesterol 1, 5

Other Lifestyle Modifications

• Smoking cessation can increase HDL cholesterol levels by up to 5-10% 4, 6
• Combining healthy diet with weight loss and physical activity can increase HDL-C by 10% to 13% 5

Pharmacological Options

• Fenofibrate is indicated as adjunctive therapy to diet to increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia 7
• Fenofibric acid, the active metabolite of fenofibrate, increases HDL and apolipoproteins apo AI and apo AII 7
• Niacin (nicotinic acid) is the most effective drug for raising HDL cholesterol but should be used with caution in patients with diabetes as it can affect blood glucose levels 2, 1

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 4
• Relying solely on medication without addressing underlying lifestyle factors will limit long-term success 4
• The combination of statins with nicotinic acid, fenofibrate, and especially gemfibrozil has been associated with increased risk of myositis, although the risk of clinical myositis appears to be low 2

Remember that while increasing HDL-C is beneficial, the ultimate goal is to reduce overall cardiovascular risk through a comprehensive approach to lipid management and cardiovascular health.