Nonpharmacologic management of low levels of high-density lipoprotein cholesterol

Several nonpharmacologic approaches can effectively increase low serum levels of high-density lipoprotein cholesterol (HDL-C), including weight control, specific nutritional choices, exercise, alcohol consumption, and smoking cessation. Increased visceral fat is inversely associated with HDL-C in both men and women. During weight reduction, HDL-C, HDL2-C, and apolipoprotein A-1 (apo A-1) tend to decrease, but levels increase with sustained weight loss. Overall, weight cycling is not detrimental in terms of serum lipids. Increasing monounsaturated fat intake and reducing carbohydrates increases HDL-C levels. Lowering trans-fatty acid intake also improves serum lipids. A very low-fat diet combined with stress-lowering lifestyle changes has been shown to cause regression of coronary artery disease. Moderate alcohol consumption, even in diabetic patients, and smoking cessation can increase serum HDL-C levels.