HDL particles are heterogeneous. They can be classified as a larger, less dense HDL2 or a smaller, denser HDL3.  Normally, most of the plasma HDL is found in HDL3.  To add to the complexity of HDL classification, HDL is composed of 4 apolipoproteins per particle. HDL may be composed of apo A-I and apo A-II or of apo A-I alone. HDL2 is usually made up only of apo A-I, while HDL3 contains a combination of apo A-I and apo A-II. HDL particles that are less dense than HDL2 are rich in apo E.
Perhaps most disappointing of all, a new class of drugs (the so-called CETP-inhibitors), which several pharmaceutical companies have been enthusiastically developing for several years to raise HDL levels, has become a great disappointment. While these drugs do indeed increase HDL levels, they have not demonstrated an ability to improve cardiac risk — and on the contrary, studies appear to show a worsening in cardiac risk with some of these drugs. It is unclear today whether any CETP-inhibitors will ever reach the market.
Flavor foods with herbs and spices whenever you can. It’ll help you cut back on condiments high in saturated fat while maximizing flavor. Spices and herbs also pack antioxidants, which can help improve cholesterol levels when combined with veggies. Ones we love: Basil, cilantro, rosemary, sage, ginger, garlic, tarragon, black and red chili pepper, mint, and oregano.
DAVID MONTGOMERY: The ways to reduce your bad cholesterol have a lot to do with your lifestyle. So your diet is really important. And although this kind of sounds trite, really one of the best and most effective ways to reduce cholesterol is by having a low fat diet, particularly saturated fat. We find saturated fat in eggs, dairy, and red meat. If you're able to reduce those, you reduce your bad fat, which reduces your bad cholesterol. Another really effective way that I use with my patients all the time to reduce your cholesterol is regular exercise. If you're doing aerobic type exercises, most days a week, four days a week, 30 minutes at a time, then you're doing your body the best amount of good, not just from lowering your cholesterol standpoint, but from so many different ways. There are other ways that we can reduce the fat. It may have to do with supplementations or medications. In some people, they are born with genetic conditions that predispose them to have very, very high cholesterol. And as a result of that, they have different problems like heart attacks or strokes. In those people, they really do benefit from cholesterol lowering drugs. But there are other things that you can get from over-the-counter, like omega fatty acids, omega-3 fatty acids in particular. They come in krill oil or fish oil. We've all heard of these before. And those help reduce parts of your cholesterol.
Cholesterol is carried through the bloodstream attached to two different compounds called lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL). LDL is commonly known as the “bad” cholesterol because it transports cholesterol from the liver throughout the body, and potentially allows it to be deposited in artery walls. HDL, known as the “good cholesterol,” picks up cholesterol from the blood and delivers it to cells that use it, or takes it back to the liver to be recycled or eliminated from the body.
It’s harder to increase HDL or "good" cholesterol than it is to lower LDL or total cholesterol. It’s estimated that up to 80 percent of the variation in HDL from person to person is due to genetic factors. But the following steps have been shown to boost HDL—and they are worth taking because they also lower total cholesterol and help protect the heart in many ways beyond their effect on HDL.
Avocados are an excellent source of monounsaturated fatty acids, which boost HDL and lower LDL. In a 2015 study published in the Journal of the American Heart Association, eating one avocado a day while following a moderate-fat diet was associated with a 13.5 mg/dL drop in bad cholesterol, or LDL, levels. Several other blood measurements were also improved in the participants who consumed an avocado a day, including total cholesterol, triglycerides, small dense LDL, non-HDL cholesterol, and others.
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society