What does an HDL level of 33 mg/dL mean? Are there symptoms associated with this HDL level? 

An HDL cholesterol level of 33 mg/dL is considered very low. Very low HDL cholesterol is associated with an increased risk of heart disease and stroke. 

Very low HDL cholesterol doesn’t have symptoms, which is why it’s important to know your levels. Increasing your HDL cholesterol to >60 mg/dL will likely help lower LDL “bad” cholesterol and triglyceride levels, as well as your risk for developing heart disease and other health issues.

Factors that could contribute to an HDL level of 33

Several factors can affect HDL levels, including your diet, weight, physical activity level, and whether or not you smoke. Medications, certain diseases, and your age, sex, race, and genetics also impact HDL levels.

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

• Weight. Having excess fat, particularly around the abdomen, can also lower HDL.

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

• Smoking. Smoking lowers HDL cholesterol which can contribute to elevated LDL (bad) cholesterol.

• Medications: Certain medications can lower HDL levels. These include beta-blockers (a common blood pressure medicine), anabolic steroids (including testosterone), progestins (found in some birth control pills and hormone replacement therapy), and benzodiazepines (used for anxiety and insomnia).  

• 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 levels typically decrease after menopause. 

• Genetics (heredity): Family members commonly have similar cholesterol levels, suggesting your genes can raise your risk of unhealthy cholesterol 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 33?

Consult your doctor if your HDL cholesterol level is 33 mg/dL, as they will need to evaluate your total cholesterol level to determine the best treatment plan. Your doctor may prescribe cholesterol-lowering medication if your LDL (“bad”) cholesterol and triglycerides are also 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 active every day. Aim for 30-60 minutes of exercise 5x/week.

• Eat more fiber-rich foods, notably beans and whole grains.

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

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

• Lose weight if you are overweight or obese.

• Quit smoking.

• Manage stress and get adequate sleep as stress triggers inflammation that can lower HDL.

Medications and supplements used to improve HDL results

Medications

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

• Fibrates: May help raise HDL in addition to reducing triglyceride levels.

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

Supplements

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

• (Algal) Omega-3: Made from certain marine algae, DHA-rich algal oil might help increase HDL cholesterol and lower triglycerides; however, it also seems to increase LDL (bad) cholesterol [10]. Most research has involved patients without heart disease.

• 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.