However, environmental factors also have a significant impact on HDL levels. Factors that elevate HDL concentrations include chronic alcoholism, treatment with oral estrogen replacement therapy, extensive aerobic exercise, and treatment with niacin, statins, or fibrates. [11, 12, 13] On the other hand, smoking reduces levels of HDL-C, while quitting smoking leads to a rise in the plasma HDL level.
Including fish in your diet can increase HDL cholesterol in a short period of time. In a study published in February 2014 in the journal PLoS One, researchers concluded that a diet rich in foods including fish showed an increase in the size of HDL particles in the body, which could help improve cholesterol transport through the body. The researchers saw the positive effects of a diet that included fish in as little as 12 weeks.
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Population studies have shown that low levels of HDL cholesterol—less than 40 mg/dL for men and less than 50 mg/dL for women—increase the overall risk of coronary artery disease (CAD) and heart attacks. A person whose HDL level is lower than 35 mg/dL has eight times the risk of CAD as someone with an HDL level of 65 mg/dL. Experts have long thought that boosting HDL levels promotes heart health. But while low HDL is a strong and well-established risk factor for heart disease, the evidence for raising HDL remains uncertain. But experts agree that taking these heart healthy steps are still worthwhile.
Not all oils are created equal when it comes to your heart health. Olive oil and soybean oil are mainly unsaturated fat, which can lower LDL cholesterol and at the same time increase HDL cholesterol. In a study published in July 2015 in The Journal of Nutrition, researchers found that including olive oil in the diet decreased LDL concentrations in healthy young men.
Once you know your cholesterol levels, it’s time to discuss a plan with your doctor. Although changing your lifestyle to include a heart-healthy diet and plenty of exercise is usually the first step to lower cholesterol, some types of cholesterol problems like familial hypercholesterolemia may require medication right away. Work with your doctor to come up with the best cholesterol goals for you and the best ways to get there.
So far, these studies have been disappointing, to say the least. The first major trial (concluded in 2006) with the first CETP inhibitor drug, torcetrapib (from Pfizer), not only failed to show a reduction in risk when HDL was increased but actually showed an increase in cardiovascular risk. Another study with another CETP inhibitor - dalcetrapib (from Roche) - was halted in May 2012 for lack of effectiveness. Both of these related drugs significantly increased HDL levels, but doing so did not result in any clinical benefit.
HDL serves as a chemical shuttle that transports excess cholesterol from peripheral tissues to the liver. This pathway is called the RCT system. In this system, plasma HDL takes up cholesterol from the peripheral tissues, such as fibroblasts and macrophages. (A study by El Khoury et al indicated that in persons with HALP, macrophages have an increased plasma cholesterol efflux capacity. [18] ) This may occur by passive diffusion or may be mediated by the adenosine triphosphate (ATP)–binding cassette transporter 1. The latter interacts directly with free apo A-I, generating nascent, or so-called discoidal, HDL. Cholesterol undergoes esterification by lecithin-cholesterol acyltransferase (LCAT) to produce cholesteryl ester, which results in the production of the mature spherical HDL. Cholesterol is also taken up from triglyceride-rich lipoproteins in a process mediated by a phospholipid transfer protein (ie, CETP). [19, 20, 21, 22]
Coronary heart disease: What you need to know The coronary arteries supply oxygen and blood to the heart. They can narrow, often because cholesterol accumulates on the arteries’ walls. This results in coronary heart disease, the most common type of heart disease in the U.S. Here, learn about risk factors, early warning signs, means of prevention, and treatments. Read now
Typically, a fasting plasma lipid profile is ordered to measure LDL, HDL, total cholesterol, and triglyceride levels. Lipids in plasma and in isolated lipoprotein fractions are quantified by enzymatic methods. Prior consumption of food has little effect on the determination of HDL, with postprandial blood samples usually yielding results that can be well interpreted. [14, 2] Current clinically available techniques can determine the cholesterol content, but not the biologic function, of HDL particles. [2]
Remember, some of the best ways to raise HDL cholesterol levels while simultaneously lowering LDL cholesterol include not smoking, exercising more, decreasing body weight, eating healthier fats, reducing refined carb intake, keeping alcohol consumption moderate, increasing niacin intake and watching your prescription drug use. Do these things and watch your HDL go up while your risk for heart disease and stroke goes down.
According to a study published in November 2015 in the journal Nature, a diet high in carbohydrates — like added sugar, white bread, cookies, and cakes — reduces HDL cholesterol levels, increasing the risk for metabolic disorders. Refined carbohydrates found in foods labeled “low-fat” make these just as bad as full-fat foods because the fat is often replaced with carbohydrates from added sugar and other starches.
Niacin (vitamin B3) is believed to block cholesterol production in the body. Although niacin in prescription supplement form appears to be most effective in increasing HDL, it may have side effects such as flushing, itching, and headache, so you may want to consider adding niacin-containing foods to your diet first. Niacin is found in high concentrations in crimini mushrooms, chicken breast, halibut, tomato, romaine lettuce, enriched bread, and cereals.
Where HDL is concerned, “you can’t be too thin,” Castelli says. One report found about a 1 percent rise in HDL for every pound of fat lost. This doesn’t mean you have to turn yourself into a toothpick, but that you should work on getting rid of excess flab as you add muscle. (Use a body-fat monitor rather than a scale to chart your progress.) Fortunately, fat loss is likely to go hand in hand with the exercise and dietary modifications that also raise HDL levels.
You've probably heard that fried foods of all kinds, hydrogenated oils, and full-fat dairy products are cholesterol bombs that are best avoided (and not just by those watching their cholesterol levels). The American Heart Association recommends that everyone restrict these foods, as they contain trans and saturated fats, the "bad" kind that raises LDL cholesterol and leads to plaque buildup in the arteries.

There is considerable controversy over whether high cholesterol is in itself a cause of heart disease (the lipid hypothesis), or a symptom of an inflammatory condition that is the true cause of heart disease (the inflammation hypothesis). According to the latter theory, chronically high levels of inflammation creates small lesions on arterial walls; the body sends LDL to heal those lesions, but it ultimately accumulates and oxidizes, causing blockages. From this perspective, the best lifestyle approach to lower cardiovascular disease risk is to lower inflammation in the body rather than LDL levels.
What is cholesterol ratio and why is it important? There are two types of cholesterol. One is harmful, and builds up in the arteries, but the other can actually benefit the body. In this MNT Knowledge Center article, learn about the difference between 'good' and 'bad' cholesterol. How do they affect the body? How can you manage high cholesterol? Read now

Eating seafood twice per week is a surefire way to reduce your risk of cardiovascular disease. Fatty fish like salmon yields some of the greatest anti-inflammatory and heart-healthy benefits, as a Journal of Nutrition study found salmon protein to significantly increase the proportion of HDL cholesterol. One tip: fish should be purchased wild and sustainably caught. For a consumer guide on how to make informed choices you can check out the consumer guides provided by the Monterey Bay Aquarium Seafood Watch.
HDL particles are heterogeneous. They can be classified as a larger, less dense HDL2 or a smaller, denser HDL3. [16] Normally, most of the plasma HDL is found in HDL3. [17] 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.
While diet and exercise should be your two main options for fighting off LDL cholesterol, you can also look into the various dietary supplements that are on the market today. Consider omega-3 fish oils, artichoke extract, and green tea extract. Keep in mind that these natural products have not been fully proven to reduce your level of LDL cholesterol, but they may be able to help along the way.
HDL levels below 40 mg/dL are associated with an increased risk of CAD, even in people whose total cholesterol and LDL cholesterol levels are normal. HDL levels between 40 and 60 mg/dL are considered "normal," and do not very much affect the risk of CAD one way or the other. However, HDL levels greater than 60 mg/dL are actually associated with a reduced risk of heart disease.
HDL cholesterol carries excess cholesterol to your liver so it doesn’t build up in your bloodstream. But when LDL cholesterol moves cholesterol throughout your body, it can build up in the walls of the arteries, making them hard and narrow. If you have too little HDL cholesterol and too much LDL, you may be diagnosed with high cholesterol, a condition that can lead to atherosclerosis, angina (often experienced as chest pain), heart attack, and stroke.

Hayek T, Chajek-Shaul T, Walsh A, Agellon LB, Moulin P, Tall AR, Breslow JL. An interaction between the human cholesteryl ester transfer protein (CETP) and apolipoprotein A-I genes in transgenic mice results in a profound CETP-mediated depression of high density lipoprotein cholesterol levels. J Clin Invest. 1992 Aug;90(2):505–510. [PMC free article] [PubMed]
Different foods lower cholesterol in various ways. Some deliver soluble fiber, which binds cholesterol and its precursors in the digestive system and drags them out of the body before they get into circulation. Some give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols, which block the body from absorbing cholesterol.
Swap extra-virgin olive oil for all your other oils and fats when cooking at low temperatures, since extra-virgin olive oil breaks down at high temperatures. Use the oil in salad dressings, sauces, and to flavor foods once they’re cooked. Sprinkle chopped olives on salads or add them to soups, like in this Sicilian fish soup. Just be sure to use extra-virgin olive oil in moderation, since it’s high in calories.
Plant stanols and sterols (such as beta-sitosterol and sitostanol) are naturally-occurring substances found in certain plants. Stanols are also found as dietary supplements or are added to margarine, orange juice, and dressings. Research suggests that plant stanols and sterols may help to lower cholesterol. They are similar in structure to cholesterol and may help block the absorption of cholesterol from the intestines.
Because increasing HDL levels is thought to be such a beneficial thing, and because there is no easy or reliable way to do so, developing drugs that substantially raise HDL levels has become a major goal for several pharmaceutical companies. And indeed, several of these drugs have been developed, and have led to clinical trials to demonstrate their safety and efficacy.
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As a result of all this, doctors don’t just want you to lower your total cholesterol count; they want you to change the ratio as well, so you have more HDL and less LDL. “When we looked at the data, we found that the higher your HDL went, the lower your risk of heart attack,” says cardiologist William Castelli, M.D., former director of the Framingham Heart Study in Massachusetts. An HDL level of 75 or more seems to convey extra longevity for many people, while a count of 100 or more is so beneficial that it was dubbed the “Methuselah syndrome” by one researcher. HDL less than 35 or so, meanwhile, can carry significant risk of heart disease. Genetics plays a large role in HDL. A few guys have naturally low levels and need to keep their LDL low as well to make up for it. (As Castelli puts it, you don’t need a substance that removes cholesterol from your blood if you don’t have much to begin with.) But there’s plenty that everyone else can do to pump up their HDL. Never one to shirk from a task that doesn’t involve housecleaning, I managed to find two handfuls of ways to turn my “good” numbers into great numbers.
Starting a simple exercise routine is another way to help lower your elevated LDL cholesterol level. And if you compound working out with the dietary tips listed above, you could potentially lower your LDL level by over 37 percent and increase your HDL cholesterol by over 5 percent in just two months. Not to mention the added benefits of losing weight, decreased stress, and higher energy, exercising is an all-around great activity to incorporate into your life. Aim for 30 minutes of physical activity, four to five times each week, and you’ll be well on your way. 
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