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.  ) 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]
Trans fats are a byproduct of the chemical reaction that turns liquid vegetable oil into solid margarine or shortening and that prevents liquid vegetable oils from turning rancid. These fats have no nutritional value — and we know for certain they are bad for heart health. Trans fats increase LDL cholesterol and triglyceride levels while reducing levels of HDL cholesterol.
A study of over 1 million US veterans showed a U-shaped relationship between HDL and total mortality, with 50mg/dL as the level associated with the lowest mortality. [7, 2] In addition, an analysis of the Framingham study demonstrated that LDL and triglyceride levels modify HDL’s predictive value; CHD risk was found to be higher when low HDL was combined with high LDL and/or triglycerides as compared with the presence of low HDL levels alone. [8, 2] The relationship between HDL and CHD risk is also confounded by the presence of pro-atherogenic and inflammatory markers. 
Niacin is a B vitamin that your body uses to turn food into energy. It also helps keep your digestive system, nervous system, skin, hair and eyes healthy. Most people get enough niacin or B3 from their diets, but niacin is often taken in prescription-strength doses to treat low HDL levels. Niacin supplementation can can raise HDL cholesterol by more than 30 percent. (7)
Pasta and heart health together in one sentence seems to be an oxymoron, however with one small tweak spaghetti can become a cholesterol-busting meal. Instead of opting for white, refined noodles, choose the less-processed, vitamin-enriched counterpart: whole grain pasta. Barilla makes one that has 7 grams of fiber per serving, and — what’s more — none of the stress-fighting B-vitamins have been removed. A B vitamin known as niacin has been found to decrease LDL levels and increase HDL when taken in doses above your vitamin requirement, according to a guide to lowering your cholesterol by the U.S. Department of Health and Human Services.
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.
Could one of your current prescriptions be a cause of your low HDL levels? Possibly! Medications such as anabolic steroids, beta blockers, benzodiazepines and progestins can depress HDL levels. If you take any of these medications, I suggest talking to your doctor and considering if there is anything you can do that could take the place of your current prescription.
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.
Too much cholesterol in the blood builds up on artery walls causing hardening of the arteries (atherosclerosis). The buildup of cholesterol narrows arteries, slowing or blocking the flow of oxygen-carrying blood to the heart, which can manifest as chest pain. If blood flow to the heart is cut off because of clogged arteries, the result is damage to the heart muscle – a heart attack.
I just moved and had to go to a new doctor. At my first annual exam and lipid panel, she called me back for a consult because she wanted to put me on a statin due to “high” ldl cholestoral levels. I am female, 54, height 5’4” and weigh 130 lbs. My ldl was 123 – my triglycerides were 58. My hdl was 68. I had basically the same lipid panel 2 years ago at my last annual exam (before moving) and my doc there was not concerned other than suggesting I start a CoQ10 and Omega 3 regimen. I don’t smoke, I exercise at least 45 minutes a day (running, cycling, golf, walking, etc.) – my major weakness is sweets. Plus no heart disease in immediate family (both parents still alive at 79 & 80 – no history of stroke, etc.)
What is the difference between HDL and LDL cholesterol? The body needs cholesterol, but too much bad cholesterol can be harmful and is a major risk factor for heart disease and stroke. In this article, learn about the difference between HDL and LDL — “good” and “bad” — cholesterol, as well as how they are measured. What steps can you take to lower LDL and increase HDL? Read now
Before you begin dramatically changing your diet or taking any supplements, you should talk with your doctor and dietitian. Food is an outstanding and all-natural way to deliver more heart-healthy vitamins, minerals, and nutrients to your body. However, certain foods and supplements are off-limits because of their possible interactions with medications or prescriptions.
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. 
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.
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.
There are two types of dietary fiber: soluble (viscous) and insoluble. To receive the greatest health benefit, eat a wide variety of all high-fiber foods. Refined foods, like white bread, white pasta and enriched cereals are low in fiber. The refining process strips the outer coat (bran) from the grain, which reduces the amount of fiber that's left.
Although this breakfast choice may not satisfy your kid (or your kid-at-heart), high fiber cereals are an easy way to improve your cholesterol profile. An American Journal of Clinical Nutrition study found that high fiber oat cereals lower LDL particle number without decreasing HDL concentrations, thus improving your ratio and giving HDL levels a percentage increase. Look for a product with a minimal amount of sugar and at least 5 grams of fiber per serving. A great oat-based choice is Barbara’s Morning Oat Crunch, which has 5 grams of fiber and 6 grams of protein per cup.
Tree nuts, such as walnuts, pistachios and pecans, have been shown to lower both total cholesterol and "bad" LDL cholesterol. Nuts are high in heart-healthy monounsaturated fat, fiber and several vitamins and minerals that are good for heart health. Nuts also contain plant sterols, which are natural compounds that block the cholesterol you eat from entering your bloodstream. While nuts are awesome to eat, don't go crazy. Portion control is still important—there are 163 calories in just 1 ounce of almonds. Add a small handful to oatmeal, top toast with nut butter or make a DIY trail mix with dried fruit and nuts.
Once you control your protein and starch portions, you can fill the rest of your plate with heart-healthy fruits and vegetables. Aim for four to five servings of vegetables and four to five servings of fruits every day. Fruits and vegetables are rich in vitamins and minerals and are great sources of fiber, which helps fill you up, control your weight, and improve cholesterol levels.
According to the Mayo Clinic, ideal HDL levels for both men and women are 60 milligrams of cholesterol per deciliter of blood. If a man’s HDL level is below 40 milligrams of cholesterol per deciliter of blood or a woman’s HDL level is below 50 milligrams of cholesterol per deciliter of blood, then disease risk, specifically heart disease, is considered to be heightened. Even if your HDL level is above the at-risk number (but below the desirable number), you still want to work on increasing your HDL level so you can decrease your heart disease risk. (9)
They're crisp, sweet and their hefty cargo of natural fiber, much of it in the form of pectin, helps to knock down LDL levels. Surprisingly, fresh pears contain even more pectin than apples do. Pectin binds with cholesterol and ferries it out of the body before it can be absorbed. A medium-size pear provides 16 percent of the recommended daily value for fiber. Other pectin-rich fruits include apples, bananas, oranges and peaches.
HDL plays an important role in transporting cholesterol from the peripheral tissues to the liver, where it can be excreted; this process is known as reverse cholesterol transport (RCT). (The liver is the main organ for excretion of cholesterol, doing so either directly or by converting cholesterol into bile acids.) It is important to remember that most HDL measured in the blood is derived from the liver and intestine. Therefore, the concentration of HDL in plasma does not reflect cholesterol efflux from blood vessels or the efficiency of RCT. Moreover, HDL function in RCT is not mirrored by HDL measurements. 
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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.
Fish can be fatty or lean, but it’s still low in saturated fat. Eat at least 8 ounces of non-fried fish each week, which may be divided over two 3.5- to 4-ounce servings. Choose oily fish such as salmon, trout and herring, which are high in omega-3 fatty acids. Prepare fish baked, broiled, grilled or boiled rather than breaded and fried, and without added salt, saturated fat or trans fat. Non-fried fish and shellfish, such as shrimp, crab and lobster, are low in saturated fat and are a healthy alternative to many cuts of meat and poultry.
Part of the “French paradox”-lower heart-disease rates in butter-and-cream-feasting France-may stem from the HDL benefits of wine consumption. For some people, however, alcohol causes more troubles than it cures. “Men should limit themselves to one or two drinks a day,” Willett says. “After that, you start worrying about adverse consequences.” While any alcoholic beverage will do, the antioxidants in red wine or dark beer may give you an added benefit.
Rich in omega-3 fatty acids and all-around delicious, walnuts have also been shown to improve the HDL-to-total cholesterol ratio, according to a study published in the American Diabetes Association’s peer-reviewed journal, Diabetes Care. This ratio is used by physicians to assess overall cardiovascular risk and can provide more information than just one value alone. A desirable ratio is anything below 5:1, but a ratio of 3.5:1 indicates very minimal cardiovascular risk.
Large doses of vitamin B3, or niacin, have been found to raise HDL as much as 20 percent and are often prescribed for people with cholesterol problems. But keep in mind that a daily multivitamin contains all the niacin most people need. Supplementing beyond that can have a variety of side effects, including facial flushing, heartburn and even liver damage, so don’t try it without consulting a doctor.