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As a rule-of-thumb, people with higher HDL have a lower incidence of cardiovascular disease (CVD). However, there's no definitive proof that HDL has a preventative effect on CVD. Higher HDL may be an indicator of some other process that reduces CVD. HDL is lowered by acute and chronic inflammatory states. For example, having a cold will temporarily lower HDL.

HDL does play a role in a process called reverse cholesterol transport. Whether that process reduces CVD is not certain. HDL also transports anti-oxidant enzymes throughout the body, which may explain some of its beneficial effects.

There have been few studies demonstrating that raising HDL reduces CVD. For example, niacin has been shown to reduce CVD mortality, although it's not proven that it's because it raises HDL. Most studies have only increased HDL by 10%, which may not be enough for a significant clinical effect.

Diet does play a role in HDL levels. Diets that are high in refined carbs or low in fat reduce HDL. On the other hand, low carb diets high in saturated fats can profoundly increase HDL levels. On of the most effective saturated fatty acids that increases HDL is lauric acid, which is primarily found in coconut.

Recent studies have also shown that saturated fat consumption is not associated with CVD. The majority of studies that claim to show a link failed to control for other factors such as sugar or polyunsaturated fat consumption.

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