HDL Cholesterol
HDL-C· also: HDL-C, Good Cholesterol
Clinical Overview
HDL (high-density lipoprotein) cholesterol transports excess cholesterol from peripheral tissues back to the liver for excretion (reverse cholesterol transport). It is called "good cholesterol" because higher levels are associated with lower cardiovascular risk. HDL also has anti-inflammatory and antioxidant properties.
Why This Test Matters
Low HDL-C (below 40 mg/dL in men, below 50 mg/dL in women) is an independent risk factor for coronary heart disease, included in the ATP/NCEP cardiovascular risk assessment. Unlike LDL-C, raising HDL pharmacologically has not consistently reduced cardiovascular events in trials (CETP inhibitors). Therefore, current guidelines focus on LDL lowering rather than HDL raising. Lifestyle changes (exercise, smoking cessation, moderate alcohol, weight loss) raise HDL modestly.
Reference RangesWHO/IFCC standards
| Age Group | Sex | Reference Range | Unit | Notes |
|---|---|---|---|---|
| Adults (18–64) | Male | 40 – 60 | mg/dL | >60 is cardioprotective |
| Adults (18–64) | Female | 50 – 60 | mg/dL | >60 is cardioprotective |
Also reported in: mmol/L.
What Causes Abnormal Results?
High HDL-C Causes
- Regular aerobic exercise
- Moderate alcohol consumption
- Genetics (familial hyperalphalipoproteinemia)
- Estrogen therapy
- Fibrate medications
- Niacin (nicotinic acid)
Low HDL-C Causes
- Sedentary lifestyle
- Obesity
- Type 2 diabetes and insulin resistance
- Smoking
- Hypertriglyceridemia
- Genetic conditions (Tangier disease)
- Medications: beta-blockers, thiazides, progestins, anabolic steroids
Signs & Symptoms to Watch For
How to Prepare for This Test
Fasting for 9–12 hours preferred. Avoid heavy alcohol use 24 hours before testing.
Factors That Can Affect Results
- Acute illness (HDL drops significantly during acute phase response)
- Recent vigorous exercise (can transiently raise HDL)
- Medications: beta-blockers, thiazides, progestins lower HDL; fibrates, niacin, statins raise HDL modestly
Related Topics
Frequently Asked Questions
What is the best way to raise HDL cholesterol?
The most effective lifestyle strategies to raise HDL are: regular aerobic exercise (adds 5–10% to HDL), smoking cessation (raises HDL by 5–10%), moderate alcohol consumption (raises HDL but does not justify starting drinking), and weight loss. Niacin was the most effective drug for raising HDL but failed to reduce cardiovascular events in major trials. Fibrates raise HDL modestly. No drug reliably improves outcomes specifically by raising HDL.