HDL Cholesterol

What is HDL cholesterol?

HDL cholesterol is a substance in your blood that helps your healthcare provider understand your risk for cardiovascular disease. It’s a type of lipid. You’ll see HDL cholesterol (also called HDL-C) on your lipid panel results along with things like LDL cholesterol, VLDL cholesterol and triglycerides.

In general, an HDL cholesterol level on the higher end of normal suggests your risk for heart disease is lower. This makes HDL cholesterol different from LDL cholesterol, which you should keep low.

But you don’t want your HDL cholesterol to be too high. Abnormally high levels may suggest that there’s an underlying dyslipidemia (abnormal balance between good and bad cholesterol). Your provider will help you keep your HDL cholesterol in the normal range to support your heart and overall health.

What is HDL?

HDL stands for high-density lipoprotein. A lipoprotein is a particle made of lipids and proteins.

Lipoproteins circulate in your blood. They’re a bit like buses. Their main job is to transport cholesterol throughout your body to cells that need them. Cholesterol needs a ride because its chemical structure keeps it from traveling solo through your blood.

HDL is just one type of “bus” that travels in your blood. LDL and VLDL are other types. Your lipid panel shows the amount of cholesterol traveling on each type of bus at the moment your blood is drawn.

That means HDL cholesterol and HDL aren’t really the same thing. HDL refers to the particle or “bus,” and HDL cholesterol refers to some of the passengers on that bus. But most people use both terms to refer to the cholesterol level in your blood.

Why is HDL called “good” cholesterol?

HDL particles are “good” because experts have linked levels on the higher end of normal with a lower risk of heart disease. HDL particles pick up extra cholesterol in your blood and deliver it to your liver. Your liver then breaks down this cholesterol and sends it out of your body through your poop. That’s a good thing because too much cholesterol in your blood raises your risk of plaque buildup in your artery walls.

You need enough HDL particles in your blood to pick up excess cholesterol and carry it to your liver. HDLs are also helpful because they combat inflammation and play a role in preventing blood clots.

What is the normal range for HDL cholesterol?

Here are the normal and abnormal HDL cholesterol ranges for adults, which vary by sex:

• Low HDL: Below 40 mg/dL (males) or below 50 mg/dL (females)
• Normal HDL: 40 to 80 mg/dL (males) or 50 to 80 mg/dL (females)
• High HDL: Above 80 mg/dL (everyone)

For kids and teens, a normal HDL level is 45 to 80 mg/dL.

Causes of low HDL

There are many reasons why your HDL cholesterol may be low, including:

• Metabolic syndrome: This is a combination of cardiovascular disease risk factors, including lower-than-normal HDL levels.
• A BMI greater than 25: Having overweight or obesity can lower your HDL level.
• Smoking or tobacco use: Tobacco contains nicotine, which lowers your HDL level. All tobacco products, including e-cigarettes, have this harmful effect.
• Insulin resistance: Excess fat can make it difficult for insulin in your body to manage your blood sugar well. This can cause a low level of HDL.
• Familial combined hyperlipidemia: This genetic condition causes your HDL cholesterol to be too low and your LDL cholesterol to be too high.
• ApoA1 deficiency: People with this genetic condition don’t have enough Apolipoprotein A1. This is a key component of HDL.
• Tangier disease: This genetic condition causes your HDL cholesterol to be too low.
• Medicines you take: Some drugs, like beta-blockers, certain hormones or some diuretics, can lower your HDL cholesterol level temporarily. But this doesn’t mean you should stop taking your other medications, as this could further increase your risk for heart disease.

Causes of high HDL

Your HDL cholesterol level may be above 80 mg/dL due to:

• Alcohol use disorder
• Hyperthyroidism
• Primary biliary cholangitis
• Gene changes
• Side effects from medications

Can I influence my HDL level?

Yes. If your HDL cholesterol is too low, your provider may suggest ways to raise it. These include eating heart-healthy foods, adding more physical activity to your routine and maintaining a weight that’s healthy for you.

If your HDL cholesterol is too high, your provider will look into the cause and tell you if you need treatment.