Thanks to powerful cholesterol-lowering statin drugs, driving down low-density lipoprotein (LDL), or “bad” cholesterol, has been the primary approach to improving cholesterol levels. But there’s more to the story of cholesterol and cardiovascular risk than LDL alone. Another key player is high-density lipoprotein (HDL), the “good” cholesterol.

Higher levels of HDL are associated with lower cardiovascular risk. The good news about this good cholesterol is that simple lifestyle changes can help boost HDL, reports the June 2008 issue of Harvard Women’s Health Watch.

About HDL Cholesterol

HDL cholesterol, or "good" cholesterol, appears to scour the walls of blood vessels, cleaning out excess cholesterol. It then carries that excess cholesterol -- which otherwise might have been used to make the "plaques" that cause coronary artery disease -- back to the liver for processing. So when we measure a person's HDL cholesterol level, we seem to be measuring how vigorously his or her blood vessels are being "scrubbed" free of cholesterol.

HDL Benefits

HDL also fights potentially dangerous inflammation and clot formation. According to a recent review of research on HDL, there’s some evidence that increasing HDL can reduce the risk of heart attack and stroke—even without changes in LDL.

HDL Levels

Strategies to Raise HDL Levels

• Get aerobic exercise. Regular aerobic exercise (any exercise, such as walking, jogging or bike riding, that raises your heart rate for 20 to 30 minutes at a time) may be the most effective way to increase HDL levels. Moderate to vigorous aerobic exercise can boost HDL by 5% to 10%. Recent evidence suggests that the duration of exercise, rather than the intensity, is the more important factor in raising HDL choleserol.  Aim for five 30-minute sessions per week.
• Lose weight if you need to. If you are overweight, reducing your weight should increase your HDL levels. This is especially important if your excess weight is stored in your abdominal area; your weight-to-hip ratio is particularly important in determining whether you ought to concentrate on weight loss. If you’re overweight or obese, you can boost your HDL level by about 1 mg/dL for every seven pounds lost. 
• If you smoke, quit. HDL levels rise by as much as 15% to 20% after you quit. 
• Cut out the trans fatty acids. Trans fatty acids are currently present in many of your favorite prepared foods -- anything in which the nutrition label reads "partially hydrogenated vegetable oils" -- so eliminating them from the diet is not a trivial task. But trans fatty acids not only increase LDL cholesterol levels, they also reduce HDL cholesterol levels. Removing them from your diet will almost certainly result in a measurable increase in HDL levels.
• Avoid highly refined carbohydrates, such as white-flour products. 
• Increase the monounsaturated fats in your diet. Monounsaturated fats such as canola oil, avocado oil, or olive oil and in the fats found in peanut butter can increase HDL cholesterol levels without increasing the total cholesterol.
• Add soluble fiber to your diet. Soluble fibers are found in oats, fruits, vegetables, and legumes, and result in both a reduction in LDL cholesterol and an increase HDL cholesterol. For best results, at least two servings a day should be used.
• Other dietary means to increasing HDL. Cranberry juice has been shown to increase HDL levels. Fish and other foods containing omega-3 fatty acids can also increase HDL levels. In postmenopausal women (but not, apparently, in men or pre-menopausal women) calcium supplementation can increase HDL levels.
• Have a drink. One or two drinks per day can significantly increase HDL levels. More than one or two drinks per day, one hastens to add, can lead to substantial health problems including heart failure -- and there are individuals who will develop such problems even when limiting their alcohol intake to one or two drinks per day.
• Consider medications. Drug therapy for raising HDL cholesterol levels has, so far, been less successful than for reducing LDL cholesterol.  Statins, in particular, are often not very effective at increasing HDL levels.  Of the drugs used to treat cholesterol, niacin appears to be the most effective at raising HDL levels. Niacin is one of the B vitamins. The amount of niacin needed for increasing HDL levels are so high, however, that it is classified as a drug when used for this purpose. Furthermore, "niacin" takes several forms, including nicotinic acid, nicotinamide, and inositol hexaniacinate - and all of these are labelled as "niacin." Unfortunately, only nicotinic acid raises HDL cholesterol, and this drug can be difficult to take because of its propensity to cause flushing, itching and hot flashes. In general, taking niacin to treat cholesterol levels should be supervised by a doctor. Note: niacin, cholestyramine, and gemfibrozil has been shown to increase HDL cholesterol substantially, but this drug combination can be particularly difficult to tolerate.