Exercise increases the Real Good HDL and Apolipoproteins

At the end of this article, you will know that not all HDL is good for the heart and that exercise increases the large HDL and apolipoprotein.

HDL

High-Density Lipoprotein (HDL) is commonly called good cholesterol because it removes cholesterol deposits in the arteries. A process called cholesterol efflux.

After that, the HDL brings the cholesterol back to the liver for elimination. That is called reverse cholesterol transport.

HDL cholesterol also has anti-inflammatory, antioxidative, and anti-thrombotic properties due to enzymes bound on its surface.

Exercise is well known to increase HDL. Some lipid-lowering prescription medicines are also marketed to increase HDL.

However, while exercise lowers cardiovascular risk and all-cause mortality, cholesterol-lowering drugs have not shown the same effect. Why?

That’s because not all HDLs are the same. Some are good, and some increase the risk of cardiovascular disease and death.

Cardiovascular diseases (CVD) are more than heart attacks and strokes. It also includes coronary artery disease, heart failure, arrhythmias, and valvular heart diseases.

HDL and LDL Sizes

Just like LDL, there are small and large HDLs. The designations, small and large, are called subfractions or particle sizes. Not many know about them because they are not routinely tested because of the cost.

Large LDL is associated with lower cardiovascular risk and thus considered good, while small LDL is associated with a higher risk of CVD.

I discussed LDL sizes in LDL: “Bad Cholesterol” is Not All Bad.

The same is valid with HDL. Large HDL is associated with a lower CVD risk.

In a study by Li et al., which included 591 patients, those with higher numbers of large HDL, less severe coronary artery disease, and lower incidence of major adverse cardiovascular events like myocardial infarctions, nonfatal heart attacks, ischemic strokes, heart failure, and cardiac death. [1]

In contrast, small HDL is associated with the presence and severity of CAD.[1]

Xu et al. evaluated 382 patients that had a coronary angiogram. Their HDL sizes were also measured. They found that those with increased levels of small HDL have worse coronary artery disease than those with high levels of large HDL. [2]

Large HDL has anti-oxidant, anti-inflammatory, anti-thrombotic, and other protective mechanisms.[3]

In contrast, small HDL, which develops from stressors like aging, smoking, pollutants, infection, and unhealthy food habits, cannot remove cholesterol deposits.

Fortunately, there is a way out of the grips of small HDL. Quitting smoking and avoiding a high-saturated fat and high-sugar diet can help. Pollution and infection can be avoided, and while chronologic aging is inevitable, biological age can be slowed with exercise.

By Larry D. Moore, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=69212692

Exercise and Large HDL Quantity

Aerobic or endurance exercises use large muscle groups for an extended period. Examples are cycling, swimming, walking, skiing, rowing, and running. Aerobic exercises lower blood pressure, sugar, total cholesterol, and triglyceride levels.

A study of overweight and obese men and women that did endurance training on a treadmill (3 sessions·week, progressing to 500 kcal burned per session) showed a higher level of large HDL increased and small HDL decreased. [5]

Notable is that the participants did not change their diet during the study. [5]

A meta-analysis involving 1,555 adults participating in distinct aerobic exercise programs with varying intensities showed that regular exercise increases the large HDL and LDL particles.[8]

In contrast, the CVD risk-increasing lipoproteins, the large VLDLs, and the small LDLs decreased. [8]

Exercise improves HDL Quality

“HDL quality” refers to the size, shape, and composition of proteins and lipids that determine HDL functionality.

Some studies about exercise and HDL did not show a change in the total HDL, and that’s because of the decrease in the small HDL and an increase in the large HDL percentage.

A study was done on 20 subjects with metabolic syndrome who did stationary biking for three months. [9]

High blood pressure, high triglycerides, high blood sugar, obesity, and low HDL characterize the metabolic syndrome.

After three months, the triglyceride levels decreased, but the HDL and LDL levels did not change. But something else did. Further tests showed that HDL’s anti-oxidative and anti-atherosclerotic properties improved. [9]

Additionally, the LDL became more resistant to oxidation. LDL oxidation happens before LDL becomes part of atherosclerosis.[9]

Exercise Improves HDL Quality and Quantity

Another study showed that some people get improvement in both large HDL quantity and quality.

Research on thirty-two obese black South African women showed that combined aerobic and resistance exercises lowered the number of small HDL, improved the anti-oxidant and anti-platelet, and decreased the Body Mass index. [6]

Aerobic exercise and Apolipoproteins

Apolipoproteins (Apo) are proteins that bind lipids (oil-soluble substances such as fats, cholesterol, and fat-soluble vitamins) to form lipoproteins.

There are different Apos in HDL, and they have various health effects.

Apo A1 and A2 are considered to prevent atherosclerosis formation and are antiatherogenic.

In contrast, increased Apo B100 and Very Low-Density Lipoproteins (VLDL) are atherogenic.

Recently, new research has shown that apolipoproteins and the Apo B100/Apo A1 ratio are better indicators of cardiovascular risk than total cholesterol, triglycerides, and LDL.

A meta-analysis of fifty-seven randomized controlled trials totaling 3,194 participants who exercised was analyzed. Before the study, all were sedentary. [10]

The subjects did aerobic exercise for at least moderate intensity for 12 weeks to 52 weeks. Exercise sessions ranged from 15 to 210 minutes at a time and ranged from 1.8 to 5.2 times per week. [10]

Results showed that aerobic exercises increased the antiatherogenic lipoproteins and lowered atherogenic apolipoprotein resulting in a lower risk for cardiovascular disease.

Take Away Message

Exercise increases the really good large HDL and the anti-atherosclerosis apolipoproteins.

Do not be discouraged if your repeat lipid profile shows no change or just a little increase in HDL after doing an exercise program. The quality of your HDL most likely improved.

Exercise, whether aerobic, endurance, or resistance in different intensities, can improve the number of the large HDL and its atherosclerosis-lowering properties.

As the shoe commercial said, Just Do It!

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References:

Li JJ, Zhang Y, Li S, Cui CJ, Zhu CG, Guo YL, Wu NQ, Xu RX, Liu G, Dong Q, Sun J. Large HDL Subfraction But Not HDL-C Is Closely Linked With Risk Factors, Coronary Severity and Outcomes in a Cohort of Nontreated Patients With Stable Coronary Artery Disease: A Prospective Observational Study. Medicine (Baltimore). 2016 Jan;95(4):e2600. doi: 10.1097/MD.0000000000002600. PMID: 26825910; PMCID: PMC5291580.
Xu RX, Li S, Li XL, Zhang Y, Guo YL, Zhu CG, Wu NQ, Qing P, Sun J, Dong Q, Li JJ. High-density lipoprotein subfractions in relation with the severity of coronary artery disease: A Gensini score assessment. J Clin Lipidol. 2015 Jan-Feb;9(1):26-34. doi: 10.1016/j.jacl.2014.11.003. Epub 2014 Nov 18. PMID: 25670357.
Franczyk B, Gluba-Brzózka A, Ciałkowska-Rysz A, Ławiński J, Rysz J. The Impact of Aerobic Exercise on HDL Quantity and Quality: A Narrative Review. Int J Mol Sci. 2023 Feb 28;24(5):4653. doi: 10.3390/ijms24054653. PMID: 36902082; PMCID: PMC10003711.
Cho KH. The Current Status of Research on High-Density Lipoproteins (HDL): A Paradigm Shift from HDL Quantity to HDL Quality and HDL Functionality. Int J Mol Sci. 2022 Apr 2;23(7):3967. doi: 10.3390/ijms23073967. PMID: 35409326; PMCID: PMC8999423.
Greene NP, Martin SE, Crouse SF. Acute exercise and training alter blood lipid and lipoprotein profiles differently in overweight and obese men and women. Obesity (Silver Spring). 2012 Aug;20(8):1618-27. doi: 10.1038/oby.2012.65. Epub 2012 Mar 16. PMID: 22421926.
Woudberg NJ, Mendham AE, Katz AA, Goedecke JH, Lecour S. Exercise intervention alters HDL subclass distribution and function in obese women. Lipids Health Dis. 2018 Oct 10;17(1):232. doi: 10.1186/s12944-018-0879-1. PMID: 30301473; PMCID: PMC6178267.
Sarzynski MA, Burton J, Rankinen T, Blair SN, Church TS, Després JP, Hagberg JM, Landers-Ramos R, Leon AS, Mikus CR, Rao DC, Seip RL, Skinner JS, Slentz CA, Thompson PD, Wilund KR, Kraus WE, Bouchard C. The effects of exercise on the lipoprotein subclass profile: A meta-analysis of 10 interventions. Atherosclerosis. 2015 Dec;243(2):364-72. doi: 10.1016/j.atherosclerosis.2015.10.018. Epub 2015 Oct 17. PMID: 26520888; PMCID: PMC4663138.
Sarzynski MA, Burton J, Rankinen T, Blair SN, Church TS, Després JP, Hagberg JM, Landers-Ramos R, Leon AS, Mikus CR, Rao DC, Seip RL, Skinner JS, Slentz CA, Thompson PD, Wilund KR, Kraus WE, Bouchard C. The effects of exercise on the lipoprotein subclass profile: A meta-analysis of 10 interventions. Atherosclerosis. 2015 Dec;243(2):364-72. doi: 10.1016/j.atherosclerosis.2015.10.018. Epub 2015 Oct 17. PMID: 26520888; PMCID: PMC4663138.
Casella-Filho A, Chagas AC, Maranhão RC, Trombetta IC, Cesena FH, Silva VM, Tanus-Santos JE, Negrão CE, da Luz PL. Effect of exercise training on plasma levels and functional properties of high-density lipoprotein cholesterol in the metabolic syndrome. Am J Cardiol. 2011 Apr 15;107(8):1168-72. doi: 10.1016/j.amjcard.2010.12.014. PMID: 21310370.
Wood G, Taylor E, Ng V, Murrell A, Patil A, van der Touw T, Wolden M, Andronicos N, Smart NA. Estimating the Effect of Aerobic Exercise Training on Novel Lipid Biomarkers: A Systematic Review and Multivariate Meta-Analysis of Randomized Controlled Trials. Sports Med. 2023 Apr;53(4):871-886. doi: 10.1007/s40279-023-01817-0. Epub 2023 Mar 2. PMID: 36862340; PMCID: PMC10036419.

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HDL