In discussions about managing cholesterol to prevent coronary heart disease, lowering LDL (“bad”) cholesterol is often cited as the first goal. But in recent years there has been growing emphasis on low levels of HDL (“good”) cholesterol as an independent risk factor for coronary heart disease. People with HDL cholesterol levels below 40 mg/dL have a significantly elevated rate of heart attacks. About 30% of people with coronary heart disease have low HDL cholesterol levels but normal levels of LDL cholesterol. The American Heart Association (AHA) and the American Diabetes Association currently recommend that HDL levels be above 40 mg/dL for men, and above 50 mg/dL for women. However, the greatest benefits seem to come when a person’s HDL level is over 60 mg/dL. Cholesterol HDL ratio is also important. The total cholesterol to HDL ratio is determined by dividing the total cholesterol level by the HDL cholesterol level. For most people, the goal is to keep this ratio below 5:1, with the ideal ratio being below 3.5:1.

HDL cholesterol exerts its good effects on the heart by removing cholesterol from the artery walls, thereby reducing the risk of atherosclerosis. In addition, there is intriguing evidence that having a high HDL level can even boost a person’s overall longevity.

As people grow older, a high HDL level seems to be a good marker for longevity. Once someone reaches age 85, low levels of HDL cholesterol—rather than high levels of LDL cholesterol—are associated with an increased risk of death from heart disease and stroke, according to a recent Dutch study in the Archives of Internal Medicine.

In this study, a group of 599 individuals aged 85 years were followed for 4 years, during which time 152 of them died. People with low levels of HDL cholesterol were twice as likely to die of a heart attack and 2.5 times more likely to have a fatal stroke, compared with those who had high HDL levels. Low HDL - as well as low LDL-levels more than doubled the risk of dying of infection.

Research recently published in the Journal of the American Medical Association determined that many people who live exceptionally long, healthy lives - average age of study participants was 98 years—share a particular gene mutation that leads to higher HDL levels as well as larger HDL and LDL particles than those present in the general population.

It has been suggested that larger LDL particles may protect against cardiovascular disease because such large particles cannot readily penetrate the walls of arteries and contribute to atherosclerosis. The gene mutation responsible for high HDL levels and bigger HDL and LDL particles appears to protect against many chronic diseases associated with aging, such as heart disease, stroke, and diabetes.

Although we are not all lucky enough to inherit the “longevity gene,” there is much that we can do to raise our HDL level (and consequently decrease cholesterol HDL ratio) on our own - and perhaps increase our odds for a longer and healthier life.

• Quit smoking. HDL levels average 4 to 6 mg/dL lower in smokers compared with nonsmokers. Quitting smoking can help raise your HDL as well as reduce your risk of heart disease and lung cancer.

• Increase your physical activity. Aerobic exercise is physical activity that uses large muscle groups rhythmically and continuously and elevates the heart rate and breathing for a sustained period. Regular aerobic exercise—any activity such as running, brisk walking, cycling, swimming, or dancing that raises the heart rate for 20 to 30 minutes at a time—can help boost HDL levels. Strength training, though it has many other benefits, does not affect HDL.

• Lose weight. If you are overweight, losing the excess pounds is an effective strategy for raising HDL and lowering cholesterol HDL ratio. Experts estimate that for every 7 lbs. you drop, your HDL level will climb by 1 mg/dL.

• Alter your diet. Trans fatty acids, found in margarines and many baked goods, can lower HDL levels and should be avoided. Instead, you should try your best to incorporate healthier monounsaturated fats, such as olive oil and canola oil, into your diet because they can help improve HDL levels and lower cholesterol HDL ratio.

• Drink alcohol in moderation. People who drink in moderation - for example, consuming about 2 to 6 ounces of wine with their evening meals - can raise their HDL levels significantly. However, because of the potential risks of alcohol consumption, experts do not recommend that lifelong non-drinkers start drinking just to boost their HDL and lower cholesterol HDL ratio. Extra Help with Medication Many people are unable to raise their HDL level sufficiently with lifestyle changes alone and may need to combine these healthy habits with one or more medications.

• Fibrates. The fibrates gemfibrozil (Lopid) and fenofibrate (Tricor) are an effective therapy for people with high triglycerides and low HDL levels, raising HDL by an average of 5% to 15%.

• Niacin. Niacin is the most potent drug currently available for raising HDL levels - it boosts HDL from 15% to 35% depending on the daily dose. In a study reported in Annals of Internal Medicine in January, 2005, niacin combined with gemfibrozil and cholestyramine raised HDL levels by 36% and caused regression of fatty plaques in coronary arteries. Niacin is available in over-the-counter preparations, but because it can cause serious side effects, you should take it only under your doctor’s supervision. Niacin may cause facial flushing, but this effect can be minimized by taking an extended-release preparation (Niaspan), which is available only by prescription. Taking the drug at bedtime with aspirin and a low-fat snack can help further reduce flushing. Niacin can also cause headache, indigestion, itching, and nausea, as well as gout and liver damage.

• Thiazolidinediones. Rosiglitazone (Avandia) and pioglitazone (Actos) are antidiabetic drugs, which may be an option for boosting HDL levels if you have diabetes.

• Torcetrapib. Torcetrapib is an experimental drug that was shown to more than double HDL levels in a recent study published in The New England Journal of Medicine. Torcetrapib and similar HDL-raising drugs are currently undergoing further testing in clinical trials.

Increase your odds for a longer and healthier life - increase HDL level and keep cholesterol HDL ratio below 5:1.