High Density Lipoprotein (HDL) is the "good" cholesterol. HDL and triglycerides (TG) are most responsive to exercise. While TG level is an independent risk factor for coronary heart disease (CHD), increasing your HDL level is like getting free brownie points. A HDL >40 mg/dl is desirable, but a HDL >60 mg/dL counts as a “negative” risk factor. Meaning it removes one CHD risk factor from the total count (National Heart, Lung, and Blood Institute, 2003).
The ATP III Cholesterol Guideline recommendations for low HDL plus elevated TG are (1) intense weight management, and (2) increased physical activity (National Heart, Lung, and Blood Institute, 2003). The Dietary Guidelines for Americans (U.S. Department of Agriculture, 2010) recommendation for exercise (adults ages 18-64) is minimum of 150 minutes of moderate intensity physical activity per week or 75 minutes of high intensity physical activity per week.
Lowering both HDL and TG may decrease the need for a multi-drug regimen to manage mixed dyslipidemia (elevated total cholesterol, elevated LDL, elevated TG, and low HDL). Combination therapy increases the risk for adverse reactions from any one drug individually (Edmunds & Mayhew, 2013). The ATP III Cholesterol Guideline (National Heart, Lung, and Blood Institute, 2003) provides information to assists in choosing drug therapy to increase HDL and lower TG:
While HDL and TG are important, the combination of LDL, blood pressure, and HDL (plus certain risk factors such as diabetes) remain the major predictors of CHD in older adults (Dunphy, Winland-Brown, Porter, Thomas, 2011). See Stratified Risk for CHD. See other Cardiovacular blogs.
Dunphy, L., Winland-Brown, J., Porter, B., Thomas, D. (2011). Primary care: The art and science of advanced practice nursing. Philadelphia, PA: F. A. Davis Company.
Edmunds, M., & Mayhew, M. (2013). Pharmacology for the primary care provider (4th ed). St. Louis, MO: Elsevier Mosby.
National Heart, Lung, and Blood Institute. (2003). ATP III cholesterol guidelines at a glance. Retrieved from http://www.nhlbi.nih.gov/guidelines/cholesterol/atglance.pdf.
U.S. Department of Agriculture. (2010). Dietary guidelines for Americans 2010. Retrieved from http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf.