HDL-C is a strong independent predictor of cardiovascular disease risk despite its
causality not being established. LDL-C, unlike HDL-C, is actually a firmly established
causal factor in dyslipidemia. Since HDL-C in plasma reflects factors beyond cholesterol efflux capacity (CEC), including net production and catabolism, metabolism of different particles like HDL3 (a smaller subfraction more prone to breakdown vs. HDL2), merely increasing HDL-C in plasma does not seem to reduce cardiovascular disease risk significantly.
Cholesterol Efflux Capacity (CEC) is the capacity of HDL particles to accept cholesterol from macrophages, engulfing (phagocytosis) oxidized LDL particles that would otherwise tend to accumulate in the arterial wall (i.e., artherosclerosis). Cholesterol efflux, then, is the process of macrophagal-phagocytotic removal of these oxidized LDL from the arterial wall to the liver (protecting arteries from deterioration). This is the function of HDL-C that we care about.
A more meaningful target for reducing cardiovascular disease risk is to lower Apo B / Apo A1 ratio (or increase Apo A1 / Apo B ratio).
Apo A1 is associated with HDL & chylomicrons that transport lipids absorbed by intestines to rest of body (reflecting CEC). Apo B-100 is associated with VLDL & gives insight into LDL actually in bloodstream circulation (reflecting atherosclerotic risk).
There are not any currently available safe drugs that increase CEC (cardarine, e.g., is highly carcinogenic). Statins are a great way to reduce LDL. The efficacy of treatments like LXR agonists, miR-33 inhibitors, LCAT enhancers, etc. to reduce cardiovascular disease risk have not been established.
But beyond all that, an easy way to improve Apo B / Apo A1 ratio is to refrain from AAS (
[link]) & insulin use (directly stimulates liver VLDL synthesis). Relatively, testosterone confers some protection against dyslipidemia by aromatization to E2 (estrogens are protective), nandrolone somewhat less, and on the extreme opposite end are potent 17AA orals that do not aromatize. Obviously, losing body fat & eating a low calorie, low saturated fat/cholesterol diet, is an effective means to reduce CVD risk.