What does an HDL level of 45 mean? Are there symptoms associated with this HDL level? 

An HDL cholesterol level of 45 mg/dL is considered low. Higher levels of HDL (>60 mg/dL) are associated with a lower risk of heart disease, stroke, and heart attack. 

Low HDL cholesterol doesn’t have symptoms, so it’s good to know your levels. Increasing your HDL cholesterol to >60 mg/dL can help lower your LDL “bad” cholesterol and triglyceride levels and reduce your risk of developing heart disease.

Factors that could contribute to an HDL level of 45

A variety of factors can affect HDL levels, including your diet, weight, activity level, age, sex, race, and genetics. Certain medications and diseases, as well as whether or not you smoke, also impact HDL levels.

• Diet: Diets that are low in fiber and high in saturated fats, trans fats, and added sugar can lower HDL levels.

• Weight. Having excess fat, particularly around the abdomen, can lower levels of HDL cholesterol.

• Physical Activity. Being active can help increase HDL cholesterol levels and lower LDL. 

• Smoking. Smoking lowers your HDL cholesterol which can contribute to a higher level of bad cholesterol.

• Medications: Some medications can lower HDL levels in some people. These include beta-blockers, anabolic steroids, progestins, and benzodiazepines .  

• Metabolic disease/ uncontrolled diabetes: Metabolic disease and uncontrolled diabetes can cause lower HDL levels.

• Age and Sex: Women tend to have higher HDL levels than men, though their levels tend to decrease after menopause. 

• Genetics (heredity): Genetics play a role in cholesterol production, which is why family members commonly have similar levels. Though rare, very low HDL cholesterol levels can also be inherited. Medical conditions that severely lower HDL levels include Tangier’s disease and familial hypoalphalipoproteinemia.

• Race. Hispanic Americans are more likely to have lower HDL levels, whereas Blacks/African Americans are more likely to have higher levels [8]. However, other risk factors, such as high blood pressure, obesity, or diabetes, may outweigh the health benefit of higher HDL levels.

• Alcohol: Some evidence suggests moderate alcohol consumption may increase HDL levels [6]. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men aged 65 and younger [6].

What to do if your HDL level is 45?

Consult your doctor if your HDL cholesterol level is 45 mg/dL, as they will need to evaluate your total cholesterol level to determine the best course of action. Your doctor may prescribe medication if your LDL (“bad”) cholesterol and triglycerides are high. 

In the meantime, making changes to your diet and adopting healthier habits can help increase your HDL cholesterol level. Here are some things you can do to give your HDL a boost: 

• Be physically active every day. Aim to exercise for 30-60 minutes 5x/week.

• Eat more fiber, particularly from beans and whole grains.

• Avoid trans fats, like hydrogenated oils, and limit saturated fats.

• Eat small, fatty fish at least twice a week, including sardines, salmon, and mackerel.

• Lose weight if you are overweight or obese.

• Quit smoking.

• Manage stress and get adequate sleep. Stress increases inflammation that can lower HDL. 

Medications and supplements used to improve HDL results

Medications

Medications are not typically prescribed for low HDL levels alone. This is because most cholesterol medications target “bad” LDL cholesterol and triglycerides. HDL levels can increase from drugs taken to lower LDL and triglyceride levels, however. Some of these include: 

• Fibrates: Help lower high triglyceride levels but may also help raise your HDL cholesterol.

• Statins: Statins (including atorvastatin, simvastatin, and rosuvastatin) reduce cholesterol production in your liver and lower blood cholesterol. Because they typically need to be taken for life, statins are typically only prescribed if diet and lifestyle changes aren’t enough [3].

Supplements

• Niacin: Niacin is a B vitamin that, when taken at prescription doses, can block the enzyme responsible for making cholesterol in the liver. Niacin therapy can also improve HDL levels and lower triglyceride levels, although it does not appear to reduce heart disease events, like heart attacks or strokes [9]. 

• (Algal) omega-3: Made from certain marine algae, DHA-rich algal oil might help increase HDL cholesterol while lowering triglycerides, though it also seems to increase LDL (bad) cholesterol [10]. If your LDL cholesterol level is elevated, talk to your doctor before taking an algal omega-3 supplement.

• Turmeric: A spice commonly used to flavor and color curry dishes, turmeric may help increase HDL and lower pro-inflammatory markers, LDL cholesterol, and triglycerides [11]. More research is needed to determine optimal form and dosage but supplementing with 500 mg/day appears safe and potentially beneficial cholesterol.