HDL cholesterol: How to boost your 'good' cholesterol

Your doctor says you need to lower your low-density lipoprotein (LDL) cholesterol. You're working hard at that goal but now your doctor says it's important to raise your high-density lipoprotein (HDL) cholesterol. You're not sure whether you're coming or going. It might sound like a mixed message, but this one-two punch — reducing LDL cholesterol and increasing HDL cholesterol — is the best way to lower your risk of heart disease.

Understanding HDL cholesterol

Cholesterol is carried through your blood attached to proteins. The cholesterol-protein package is called a lipoprotein.

• Low-density lipoproteins. LDL, or "bad," cholesterol carries cholesterol throughout your body, depositing it along the walls of your arteries. Cholesterol buildup forms plaques that make arteries hard and narrow — ultimately increasing the risk of coronary artery disease.
• High-density lipoproteins. HDL, or "good," cholesterol picks up excess cholesterol in your blood and takes it back to your liver for disposal. The higher your HDL cholesterol, the less bad cholesterol you'll have in your blood.

The message to lower LDL cholesterol is loud and clear — but it might not be enough for people at high risk of heart disease. So doctors are beginning to turn their attention to HDL cholesterol.

In one study, every 1 percent increase in HDL cholesterol was linked to a 2 percent reduction in the development of coronary artery disease. In the same study, participants with the highest HDL levels had half the risk of developing coronary artery disease as did those with the lowest HDL levels.

Set your target

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. When it comes to HDL cholesterol, think high. Most people should aim for an HDL level of 60 mg/dL or above. An HDL level below 40 mg/dL increases the risk of heart disease.

For the average man, HDL cholesterol ranges from 40 to 50 mg/dL. Thanks to female sex hormones — which have a positive effect on HDL cholesterol — the average woman fares better, with HDL cholesterol ranging from 50 to 60 mg/dL. But both men and women can benefit from increasing those averages.

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. Smoking lowers HDL cholesterol and increases your blood's tendency to clot. If you smoke, quit. To increase your odds of success, you might want to try more than one strategy at a time. For example, combine medication to reduce nicotine cravings with a support group or individual counseling. Talk with your doctor about your options for quitting.
• Maintain a healthy weight. Excess pounds take a toll on HDL cholesterol. But there's good news. If you're overweight, losing even a few pounds can improve your HDL level. For every 2 pounds you lose, your HDL may increase by .35 mg/dL. That's about 1 mg/dL for every 6 pounds. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
• Get more physical activity. In one study, regular aerobic exercise increased HDL cholesterol by 3 percent to 9 percent in otherwise healthy sedentary adults. Try to get at least 30 to 60 minutes of aerobic activity on most days of the week. Better yet, exercise every day. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.
• Choose healthier fats. A healthy diet includes some fat, but there's a limit. In a heart-healthy diet, up to 25 percent to 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 trans fat, which raises LDL cholesterol and lowers HDL cholesterol. This includes many margarines, most commercial baked products and anything that contains partially hydrogenated vegetable oil. Monounsaturated fat — found in olive, peanut and canola oils — is a healthier option. Nuts, fish and other foods containing omega-3 fatty acids are other good choices.
• Drink alcohol only in moderation. In some studies, moderate use of alcohol (particularly red wine) has been linked with higher levels of HDL cholesterol — but the benefits aren't strong enough to recommend alcohol for anyone who doesn't drink already. If you choose to drink alcohol, do so in moderation. This means no more than one drink a day for women, and one to two drinks a day for men.

What about medication?

Some medications used to lower LDL cholesterol may also increase HDL cholesterol, including niacin, fibrates (Lopid, others) and statins (Lipitor, Zocor, others).

A study on a promising HDL-raising drug called torcetrapib was halted in late 2006 because more people than expected died while taking the experimental medication. But, while researchers continue to study other options, lifestyle changes will help you on your way to an optimal HDL level.

If your doctor prescribes medication to help control your cholesterol, take it as directed while you continue to focus on a healthy lifestyle.