Although your doctor may have told you to lower your total cholesterol, it's important to raise your high-density lipoprotein (HDL) cholesterol, which is known as the "good" cholesterol. It might sound like a mixed message, but reducing "bad" low-density lipoprotein (LDL) cholesterol and increasing HDL cholesterol may lower your risk of heart disease.
Understanding HDL cholesterol
Cholesterol is a waxy substance that's found in all of your cells and has several useful functions, including helping to build your body's cells. It's carried through your bloodstream attached to proteins. These proteins are called lipoproteins.
- Low-density lipoproteins. These lipoproteins carry cholesterol throughout your body, delivering it to different organs and tissues. But if your body has more cholesterol than it needs, the excess keeps circulating in your blood. Over time, circulating LDL cholesterol can enter your blood vessel walls and start to build up under the vessel lining. Deposits of LDL cholesterol particles within the vessel walls are called plaques, and they begin to narrow your blood vessels. Eventually, plaques can narrow the vessels to the point of blocking blood flow, causing coronary artery disease. This is why LDL cholesterol is often referred to as "bad" cholesterol.
- High-density lipoproteins. These lipoproteins are often referred to as HDL, or "good," cholesterol. They act as cholesterol scavengers, picking up excess cholesterol in your blood and taking it back to your liver where it's broken down. The higher your HDL level, the less "bad" cholesterol you'll have in your blood.
Just lowering your LDL cholesterol might not be enough for people at high risk of heart disease. Increasing HDL cholesterol also can reduce your risk of heart disease.
Although higher levels of HDL can be helpful in reducing your risk of having a heart attack, researchers caution that you should also consider other risk factors for developing heart disease. It's possible that HDL may not be as helpful for some people as others based on genetics, the size of the HDL particles and other proteins in your blood. Talk to your doctor if you're concerned about how increasing your HDL cholesterol might affect you.
Set your target HDL cholesterol level
Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood or millimoles (mmol) per liter (L). When it comes to HDL cholesterol, aim for a higher number.
| ||At risk||Desirable
||Less than 40 mg/dL (1.0 mmol/L)
||60 mg/dL (1.6 mmol/L) or above
||Less than 50 mg/dL (1.3 mmol/L)
||60 mg/dL (1.6 mmol/L) or above
If your HDL cholesterol level falls between the at-risk and desirable levels, you should keep trying to increase your HDL level to reduce your risk of heart disease.
If you don't know your HDL level, ask your doctor for a baseline cholesterol test. If your HDL value isn't within a desirable range, your doctor may recommend lifestyle changes to boost your HDL cholesterol.
Make your lifestyle count
Your lifestyle has the single greatest impact on your HDL cholesterol. Even small changes to your daily habits can help you meet your HDL target.
- Don't smoke. If you smoke, quit. Quitting smoking can increase your HDL cholesterol by up to 10 percent. Quitting isn't easy, but you can increase your odds of success by trying more than one strategy at a time. Talk with your doctor about your options for quitting.
- Lose weight. Extra pounds take a toll on HDL cholesterol. If you're overweight, losing even a few pounds can improve your HDL level. For every 6 pounds (2.7 kilograms) you lose, your HDL may increase by 1 mg/dL (0.03 mmol/L). If you focus on becoming more physically active and choosing healthier foods — two other ways to increase your HDL cholesterol — you'll likely move toward a healthier weight in the process.
- Get more physical activity. Within two months of starting, frequent aerobic exercise can increase HDL cholesterol by about 5 percent in otherwise healthy sedentary adults. Your best bet for increasing HDL cholesterol is to exercise briskly for 30 minutes five times a week. Examples of brisk, aerobic exercise include walking, running, cycling, swimming, playing basketball and raking leaves — anything that increases your heart rate. You can also break up your daily activity into three 10-minute segments if you're having difficulty finding time to exercise.
Choose healthier fats. A healthy diet includes some fat, but there's a limit. In a heart-healthy diet, between 25 and 35 percent of your total daily calories can come from fat — but saturated fat should account for less than 7 percent of your total daily calories. Avoid foods that contain saturated and trans fats, which raise LDL cholesterol and damage your blood vessels.
Monounsaturated and polyunsaturated fats — found in olive, peanut and canola oils — tend to improve HDL's anti-inflammatory abilities. Nuts, fish and other foods containing omega-3 fatty acids are other good choices for improving your LDL cholesterol to HDL cholesterol ratio.
- Drink alcohol only in moderation. Moderate use of alcohol has been linked with higher levels of HDL cholesterol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. If you don't drink alcohol, don't start just to try raising your HDL levels.
Medications and foods that may help
Some medications used to lower LDL cholesterol may also increase HDL cholesterol, including:
Niacin. Niacin (Niaspan) is usually the best medication to increase HDL cholesterol. Various prescription and over-the-counter preparations are available, but prescription niacin is preferred, as it has the least side effects. Dietary supplements containing niacin that are available over-the-counter are not effective for lowering triglycerides and may damage your liver.
You may have heard that a large study that examined the effect of niacin to raise HDL cholesterol was stopped early. This study examined how niacin worked when used with statin medications for people who have a history of heart disease. The trial was stopped because no difference was seen between people who took prescription-strength niacin and people who took a placebo. The study also found there may be a small increase in the risk of stroke for people who take niacin to increase their HDL cholesterol level. More research is necessary to see how effective niacin might be compared with other heart disease medications. You shouldn't stop taking niacin unless you get your doctor's OK. Talk to your doctor if you're concerned about taking niacin.
- Fibrates. The medications fenofibrate (Lofibra, Tricor) and gemfibrozil (Lopid) can help increase your HDL cholesterol level.
- Statins. Statins block a substance your liver needs to make cholesterol. This reduces cholesterol in your liver cells, which causes your liver to remove cholesterol from your blood. Statins may also help your body reabsorb cholesterol from built-up deposits on your artery walls. Choices include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
If your doctor prescribes medication to help control your cholesterol, take it as directed while you continue to focus on a healthy lifestyle.
Some foods may have a healthy effect on blood cholesterol levels. Some options include:
- Whole grains, such as oatmeal, oat bran and whole-wheat products
- Nuts, such as walnuts, almonds and brazil nuts
- Plant sterols such as beta-sitosterol and -sitostanol (typically found in margarine spreads such as Promise Activ or Benecol)
- Omega-3 fatty acids, such as fatty fish, fish oil supplements, flaxseeds and flaxseed oil
If you're currently taking medications, talk to your doctor before starting any supplement to avoid potential harmful interactions.