Introduction,
For years, high-density lipoprotein (HDL) cholesterol has been celebrated as “good” cholesterol. Known for its role in transporting low-density lipoprotein (LDL), or “bad” cholesterol, out of the bloodstream, HDL was long considered a marker of cardiovascular health. Studies from the 1970s showed that people with low HDL levels often had higher heart disease risks, leading to a widespread belief that boosting HDL could prevent heart problems.
Yet, recent research challenges this assumption, revealing that increasing HDL levels alone doesn’t necessarily protect against heart disease. According to Dr. Anand Rohatgi, cardiologist and professor of medicine at UT Southwestern Medical Centre, “The challenge has been that while HDL is a powerful predictor of risk, medications developed to raise it have not reduced heart disease rates.” Instead, a growing body of evidence suggests that focusing on holistic heart health habits may be a more effective strategy.
What Cholesterol Tests Really Tell Us
Cholesterol tests provide a breakdown of total cholesterol, including LDL, HDL, and triglycerides, a type of fat linked to heart disease and stroke risk when combined with low HDL or high LDL levels. Cardiologists agree that understanding one’s cholesterol profile, in concert with factors like blood pressure, age, and lifestyle, offers a more accurate risk assessment than focusing on any single number.
HDL’s function in the body does play an important role in heart health. Unlike LDL, which can form plaque and narrow arteries, HDL aids in transporting cholesterol to the liver, where it’s processed and eventually excreted. Yet, while low HDL levels are associated with higher cardiovascular risk, artificially raising HDL has not shown corresponding reductions in heart disease in studies of pharmaceuticals. In short, HDL may be a useful risk marker but not a treatment target.
The Real Power of Heart-Healthy Habits
Although medications haven’t been effective in boosting HDL’s protective effect, certain lifestyle habits have been shown to raise HDL levels naturally. These habits carry additional health benefits, likely explaining why they are linked to better heart health outcomes. Here’s a closer look at the lifestyle practices that support cardiovascular health by improving the full cholesterol profile.
- Exercise Regularly
Routine physical activity is one of the most effective ways to increase HDL levels while simultaneously lowering LDL and triglycerides. Studies show that moving for about 30 minutes a day, five times a week, can significantly benefit heart health. Dr. Melissa Tracy, cardiologist at Rush University Medical Centre, advises choosing any form of cardio exercise that’s enjoyable—whether it’s brisk walking, dancing, swimming, or cycling—as long as it raises your heart rate.
Physical activity improves cardiovascular function and metabolic health beyond just cholesterol. Exercise stimulates the release of nitric oxide, which helps blood vessels relax and lowers blood pressure. It also reduces inflammation, a critical factor in atherosclerosis, which can contribute to heart attack and stroke. By making exercise a regular habit, individuals not only raise HDL but also build stronger overall heart health.
- Eat More Unsaturated Fats
The relationship between diet and cholesterol is complex, but focusing on healthy fats can improve HDL while reducing LDL. Monounsaturated and polyunsaturated fats, found in foods like olive oil, fatty fish, nuts, and seeds, help to balance the cholesterol profile. Dr. Joy M. Gelbman, a cardiologist at Weill Cornell Medicine, explains that these fats support HDL’s role in cholesterol transport, encouraging the liver to process and excrete LDL.
Swapping saturated fats (found in red meat, full-fat dairy, and fried foods) with unsaturated fats can also improve the HDL-to-LDL ratio. Polyunsaturated fats, in particular, contain omega-3 fatty acids, which are known to reduce inflammation, lower triglyceride levels, and promote healthier blood vessel function.
- Quit Smoking
Smoking is one of the most damaging habits for heart health, significantly lowering HDL levels and compromising its protective function. According to research published in Biomarker Research, quitting smoking can increase HDL in just a few weeks. Smoking not only reduces HDL but also alters its composition, making it less effective in transporting LDL away from the arteries. The exact mechanism is still being studied, but it’s believed that the stress smoking places on the body interferes with HDL’s beneficial functions.
By quitting smoking, former smokers can improve their HDL levels and their overall cardiovascular profile. The American Heart Association notes that the benefits of quitting smoking extend beyond cholesterol: quitting can lower blood pressure, reduce blood clot risk, and improve circulation.
- Maintain a Healthy Weight
Weight management is essential to a healthy cholesterol profile. Excess weight, particularly around the abdomen, is often linked to higher levels of LDL and triglycerides and lower HDL. Shedding just a few pounds can improve these ratios. A study in Obesity Research & Clinical Practice found that participants who lost 1-3% of their body weight showed improvements in HDL levels, even with modest weight loss.
Furthermore, research suggests that weight loss achieved through a diet higher in protein and healthy fats and lower in refined carbohydrates may have the most substantial effect on HDL. Reducing added sugars and refined carbs can help prevent spikes in blood glucose and insulin, reducing the risk of metabolic syndrome, a cluster of conditions that increase heart disease risk.
The Limits of Raising HDL
Despite HDL’s role in heart health, studies show that merely increasing HDL through medication doesn’t lower heart disease risk. According to Dr. Rohatgi, “We don’t fully understand why, but simply raising HDL doesn’t change the underlying risk of heart disease. It’s a complex relationship that’s not fully understood yet.”
Pharmaceutical trials aimed at increasing HDL have largely been unsuccessful in lowering cardiovascular risks. Experts now view HDL’s benefits as correlational rather than causative, indicating that high HDL levels are associated with, but do not necessarily cause, better heart health. Instead, HDL functions as a marker of overall heart health, reflecting the positive effects of healthy lifestyle habits more than acting as a direct shield against disease.
This realization has led many cardiologists to advocate for a holistic view of heart health that considers all cholesterol metrics and lifestyle factors rather than focusing solely on HDL. Dr. Tracy notes, “The numbers are not a crystal ball.” Focusing too much on one marker can detract from the broader picture of cardiovascular risk, which includes factors like blood pressure, blood sugar levels, body mass index, and family history.
Moving Beyond HDL for Heart Health
In light of recent findings, heart health experts now encourage individuals to prioritize lifestyle changes that impact their entire cardiovascular profile rather than fixating on raising HDL alone. Maintaining a balanced diet, staying physically active, quitting smoking, and achieving a healthy weight all contribute to a more favourable cholesterol profile and lower overall risk of heart disease. These habits don’t just raise HDL; they also improve LDL, triglycerides, blood pressure, and overall longevity.
The takeaway for patients, says Dr. Rohatgi, is to “think of cholesterol as one part of the puzzle.” Heart health requires a multifaceted approach, and while HDL has its role, it’s just one of many factors. Heart disease prevention lies in combining healthy lifestyle habits, managing other risk factors, and understanding that cholesterol numbers provide just a snapshot of a much larger picture.
References
- Rohatgi, A., et al. (2022). HDL cholesterol and heart disease risk: A reassessment. Journal of Cardiology Research.
- Tracy, M., et al. (2021). Exercise, HDL, and cardiovascular health: A meta-analysis. Circulation: Heart Failure, 14(8), 512-521.
- Gelbman, J. M., et al. (2020). Dietary fats and their role in cholesterol balance. Journal of Nutrition and Heart Health, 10(3), 215-227.
- Biomarker Research. (2020). Smoking cessation and HDL: A review. Biomarker Research, 14(6), 324-336.
- American Heart Association. (2019). The impact of smoking on cholesterol and heart disease. Circulation, 139(11), e66-e70.
- Obesity Research & Clinical Practice. (2018). Weight loss and cholesterol profile improvements: An analysis. Obesity Research & Clinical Practice, 12(7), 451-459.
- Mozaffarian, D., et al. (2021). Understanding cholesterol and heart health. Nutrition Reviews, 79(4), 202-214.