Hello XXXXXX,
Thank you for the query.

I understand that your husband is 35 years of age and has low HDL level.

It is believed that HDL cholesterol is the "good cholesterol" and the current recommendation is that HDL cholesterol should be more than 40 mg/dl at least. A level more than 60mg/dl would be ideal.

There are many causes of low HDL cholesterol, including, diabetes, smoking, obesity, high carbohydrate diet, some genetic conditions, certain drugs, high triglyceride levels and a sedentary lifestyle.

I would like to know the complete lipid profile, including the values of total cholesterol, triglycerides, LDL and VLDL cholesterol also before we estimate his cardiovascular risk and how aggressively we should treat low HDL level. That is to say, if the total cholesterol level itself is 120 mg/dl, the significance of HDL of 21mg/dl would be vastly different than if, say, the total cholesterol level is 250mg/dl and the LDL cholesterol is 170 mg/dl.

The recommended way to increase HDL cholesterol level is to undertake regular exercise. Walking for half an hour daily would go a long way in improving HDL cholesterol levels. Cessation of smoking, losing weight, control of diabetes and moderation of alcohol will help.

Niacin is the specific drug which is used to increase HDL levels. However, before starting the drug, the patient has to be evaluated in detail and the correct drug combination should be chosen. Niacin does have some side effects, hence the caution.

Drugs belonging to the fibrates group also may improve HDL cholesterol especially if triglyceride levels are also high. Statins, especially rosuvastatin, have been used if the LDL cholesterol is also elevated. However, these have only a moderate effect on HDL levels.

Drug treatment for isolated low HDL levels is recommended usually if there is already coronary artery disease or if there are very significant risk factors for developing heart disease.

I hope this answers your query. Feel free to contact me for any further clarifications.
With regards,
Dr Raja Sekhar Varma, MD, DM
Consultant Interventional Cardiologist

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Dear XXXXXX,
Thank you for your kind comments.

I dont see your husband's complete lipid profile online. I only see the low HDL value that you have mentioned. If possible, please upload the complete lipid profile report.

Generally speaking, there is no specific diet to increase HDL. Rather diets are effective in lowering LDL cholesterol, triglycerides, VLDL and total cholesterol.

There are only broad principles and individual decision has to be taken depending on the food habits of the individual, other comorbid conditions, etc. Remember that diet can control only upto around 30% of the lipid abnormalities. The rest of the cholesterol is from metabolic processes in the body and as such, needs medicines to control them.

A diet XXXXXXX in vegetables and fruits is recommended. Avoid/limit the amount of oil intake. Sunflower oil and olive oil are relatively better, but even these need to taken in moderation. Avoid all fried food. The calories consumed per day should be adjusted to the needs of the body. Excess carbohydrates can be converted to fat in the body. Avoid mutton, beef and pork. Occasional chicken and fish can be taken (not fried). Avoid egg yolk. Reduce milk cream, butter, cheese, ghee and similar dairy products. Buttermilk may be preferable to curds.

Regular exercise as outlined above in the previous answer is the best way to increase HDL levels.

Hereditary causes are difficult to identify unless you test both his parents, grandparents (if possible), direct aunts/uncles, brothers and sisters.

Abnormal lipids is only one of the risk factors for heart disease. However, if the values are kept under control, there is every reason to believe that one can successfully prevent heart attacks and strokes. Periodic monitoring and optimization of treatment is a must.

Hope these words will clear all your doubts.

With regards,
Dr RS Varma

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