How can I increase my high-density lipoprotein (HDL) cholesterol?

How to Increase HDL Cholesterol

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

Exercise Interventions

• 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, 1
• A linear dose-response relationship exists between activity levels and HDL cholesterol levels - more activity generally yields greater HDL increases 2, 1, 3
• Aerobic exercise corresponding to a total energy expenditure of 1500-2200 kcal/week (equivalent to 25-30 km of brisk walking weekly) can 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
• High-intensity aerobic exercise appears more effective than moderate-intensity for improving the overall lipid profile 2
• Aim for at least 7-14 miles of jogging per week (or equivalent activity), which corresponds to approximately 1200-1600 kcal weekly expenditure 3

Dietary Modifications

• Replace saturated fats with monounsaturated fats (olive oil, canola oil) and polyunsaturated fats (corn oil, peanuts) rather than high-carbohydrate foods 1, 2
• Avoid trans fatty acids, which reduce HDL cholesterol while increasing LDL cholesterol 2, 1
• Limit high-carbohydrate diets, especially those with high glycemic index and high fructose/sucrose content, as they can decrease HDL-C levels 2, 1
• Increase dietary fiber intake through legumes, fruits, vegetables, and whole grains, which can help improve the overall lipid profile 2

Weight Management

• Weight reduction has a beneficial influence on HDL-C levels: approximately 0.01 mmol/L (0.4 mg/dL) increase for every kilogram of weight loss once weight stabilizes 2
• Combining a healthy diet with weight loss and physical activity can increase HDL-C by 10-13% 4
• Weight reduction improves insulin sensitivity and decreases triglyceride levels, which can indirectly benefit HDL-C 2

Other Lifestyle Modifications

• 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, 1
• Smoking cessation can contribute to HDL-C elevation 2, 5
• Smoking cessation can improve HDL levels by 5-10% 5

Pharmacological Options

• Nicotinic acid (niacin) is the most effective medication for raising HDL cholesterol, producing an average 20-35% increase in HDL cholesterol 6
• Fenofibrate is indicated as adjunctive therapy to diet to increase HDL-C in adult patients with primary hypercholesterolemia or mixed dyslipidemia 7
• Statin therapy, while primarily used for LDL reduction, can also result in elevation of HDL levels by at least 5% 5

Common Pitfalls and Caveats

• Simply raising HDL-C levels may not directly translate to reduced cardiovascular risk - the quality and functionality of HDL may be more important than absolute levels 8, 9
• Exercise interventions may need to exceed a certain threshold to produce beneficial effects on HDL function 8
• Moderate to low intensity exercise should be preferred for most individuals as it carries a lower risk for cardiac complications and promotes better adherence 3
• When implementing lifestyle changes, consistency is key - improvements in HDL-C are maintained only as long as the lifestyle modifications are continued 2, 9
• For patients with low HDL, achieving very low LDL levels may be the most appropriate approach for cardiovascular risk reduction 5