By now we all know that LDL cholesterol is the "bad" cholesterol and HDL is the "good" one. High levels of HDL – above 40 mg/dL if you are a man and 50 mg/dL if you're a woman – can help to protect your heart. In this article, Johns Hopkins cardiologists review essential lifestyle measures to boost your HDL levels and stay heart healthy.
The news was disappointing -- a promising drug designed to boost levels of the "good," high-density lipoprotein (HDL) cholesterol was withdrawn from research. A clinical trial, involving 15,000 individuals, was testing whether the drug in combination with a statin would help prevent heart attacks. But the trial ended abruptly in December 2006, when the drug was found to modestly increase the risk of death, compared with taking a statin alone.
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The drug, called torcetrapib, blocked the activity of a protein that helps transfer cholesterol from HDL to low-density lipoprotein (LDL) particles. The result: An average 50% increase in HDL cholesterol circulating in the blood.
The Benefits of HDL -- Unlike "bad" LDL cholesterol, a high HDL level is generally good for your heart. Research shows that low levels of HDL cholesterol are a significant heart-attack risk factor, independent of whether LDL cholesterol is high or low. Fortunately, torcetrapib is not the only way to increase levels of protective HDL cholesterol in the blood.
If your HDL cholesterol is low -- less than 40 mg/dL if you are a man or less than 50 mg/dL if you're a woman -- your doctor may recommend one or more of the strategies below.
Niacin -- The approved drug with the greatest impact on HDL cholesterol is niacin, which has been used as a cholesterol medication for about 30 years. It raises HDL levels by 20-35% on average. When used in combination with a statin or bile acid sequestrant, it can reduce the risk of heart attacks and slow the buildup of plaques in the arteries.
But niacin has some drawbacks. It dilates blood vessels, which can produce uncomfortable itching and flushing. Taking aspirin within 30 minutes of taking niacin and using an extended-release form called Niaspan can help prevent flushing. Also, taking Niaspan at bedtime with a small, low-fat snack (such as an apple or yogurt) can help.
Over-the-counter forms of niacin are available. But the high doses needed to boost HDL cholesterol require monitoring by your physician, particularly since these doses may lead to liver damage, gout, and stomach ulcers. Niacin can also raise blood glucose levels and should be used with caution in people with diabetes.
Lose Weight and Eat Better -- Drugs are only one of the means of pushing HDL levels higher. A variety of lifestyle measures can make a difference. The primary ones are weight loss and diet. In general, every 2 lbs of weight loss will produce a 0.3-mg/dL rise in HDL. In addition, a recent study found that weight loss, particularly around the waist, led to higher HDL cholesterol levels in women.
Diets low in simple carbohydrates appear to increase HDL cholesterol levels by as much as 20%, so you may want to avoid the carbohydrates found in white rice, white bread, and sugar-containing soft drinks, juices, and snacks.
Here are some other suggestions on what to eat, and what not to eat, to raise HDL levels:
Avoid trans fats, produced by hydrogenation of vegetable oils, which can lower HDL cholesterol levels (and also raise LDL cholesterol). Trans fats are commonly found in margarines, cookies, cakes, french fries, and other fast-food items.
Substitute monounsaturated vegetable oils for saturated and trans fats, and eat more fish that contain omega-3 polyunsaturated fats, such as salmon, sardines, herring, mackerel, and sea bass.
Exercise More -- If you burn 1,200-1,500 calories per week through exercise, which is the equivalent of 30 minutes of moderate-intensity activity (such as brisk walking) on most days of the week, you can raise your HDL cholesterol level. For example, a review of 10 randomized, controlled trials found that people who engaged in regular aerobic exercise (at least four times a week) had an average increase of 9% in their HDL cholesterol levels.
There's also evidence that three short bouts of aerobic exercise in one day may raise HDL cholesterol as much as one long exercise session, and that strength training can also increase your HDL cholesterol. Research shows that if exercise becomes a habit, your HDL cholesterol will stay elevated.
Stop Smoking -- Another reason to give up smoking is to raise your HDL cholesterol. Smokers have HDL cholesterol levels 5 mg/dL lower than nonsmokers on average. Exposure to secondhand smoke also lowers HDL. After as little as two weeks of quitting, a smoker's HDL cholesterol level begins to climb.
Drink—But Just a Little -- Consuming one alcoholic drink a day appears to increase HDL cholesterol by about 4 mg/dL, and the type of alcohol consumed doesn't seem to matter. However, if you're an abstainer, you should not start drinking alcohol just to raise your HDL cholesterol levels. Talk with your doctor about your level of alcohol consumption to be sure that, if you drink, you are not doing more harm than good. For instance, individuals with liver disease or alcohol abuse problems should avoid alcohol altogether.
