u/skyminee

33M, BMI 21.4. Non-smoker, regular cardio + weights, high-fiber diet (~55g/day). No medications, no known conditions. Posting my 2-year lipid trend — would love input from this community, especially anyone with experience with genetically-driven high HDL.

Between 2024→2026 I increased fiber from 25 to ~55g/day and reduced saturated fat (4-6x/week red meat down to ~2-3x). These changes should have stabilized or lowered HDL. Instead it jumped +46% in 2 years and the increase is accelerating (+18 in year 1, +24 in year 2). My total cholesterol rise (192→240) is almost entirely HDL-driven.

What concerns me:

• HDL 134 is extreme — above the 99th percentile for males. No lifestyle change explains this trajectory
• Lp(a) 61 nmol/L (25.4 mg/dl)— mildly elevated above the ≥50 threshold. First-ever measurement, genetically fixed

After researching, the profile (high HDL + low LDL + low ApoB + low TG + elevated Lp(a)) fits CETP deficiency pattern well — reduced cholesterol transfer from HDL to LDL causes HDL accumulation. Also possibly SCARB1 variants (impaired hepatic HDL uptake).

My questions for this community:

1. Has anyone here had a similar paradoxical HDL rise — HDL going well above 100 despite not trying to raise it? Did you get genetic testing? What did it show?
2. CETP deficiency carriers — if you've been identified, what was your experience? Is your high HDL considered protective or neutral?
3. With ApoB at 66 and Lp(a) at 61 nmol/L, would you start low-dose rosuvastatin (5mg) + ezetimibe (1o mg)?  The ApoB is already near the ESC high-risk target of <65, but the Lp(a) elevation arguably justifies more aggressive LDL lowering. Counter-argument: statins can raise Lp(a) by 10-20%.
4. NMR lipoprotein profile — anyone with very high HDL who got NMR testing? Curious whether these are large cholesterol-enriched particles vs. high particle count. and should I take the test?

Appreciate any insights from those who've gone down this rabbit hole.