HDL Cholesterol

What is HDL?

HDL stands for high-density lipoprotein. It’s a type of lipoprotein that circulates in your blood.

Lipoproteins are particles made of lipids (fats) and proteins. Their main job is to transport fats, such as cholesterol, throughout your body to the cells that need it. This is necessary because fats, due to their chemical structure, are unable to travel solo through your blood. They need the help of lipoproteins to get where they need to be.

What is HDL cholesterol?

You might hear HDL referred to as “HDL cholesterol,” or the “good cholesterol.” While HDL particles are technically made up of both fats and proteins, they’re most famous for the type of fat they carry (cholesterol). So, most people use “HDL” and “HDL cholesterol” interchangeably to talk about these particles and the role they play in your heart health.

HDL is the “good cholesterol” because it helps your body get rid of extra cholesterol. This process, known as reverse cholesterol transport, can lower your risk of cardiovascular disease.

Reverse cholesterol transport

Cholesterol normally travels from your liver to your bloodstream. From there, lipoproteins carry the cholesterol to different cells in your body to support important functions (like helping with cell membrane formation and hormone production). But sometimes, there’s too much cholesterol in your blood. It’s more than your body needs. That’s when reverse cholesterol transport helps.

Reverse cholesterol transport is a complex body process, and researchers continue to explore how and when HDL plays a role. What we know is that HDL particles can transport excess cholesterol from your bloodstream back to your liver. Your liver then breaks down this cholesterol and gets rid of it from your body. This is a good thing because too much cholesterol in your blood raises your risk of plaque buildup in the artery wall (atherosclerosis).

Therefore, HDL is the helpful cholesterol. HDL is the one cholesterol number in your lipid panel that should be higher rather than lower.

What is the HDL cholesterol normal range?

Ideally, your HDL should be 60 milligrams per deciliter (mg/dL) or higher. Research shows this can lower your risk of cardiovascular disease.

However, these are the normal ranges for adults:

• 40 or higher in people assigned male at birth (AMAB).
• 50 or higher in people assigned female at birth (AFAB).

If your HDL is below your target range, it’s considered low.

It’s important to talk to your healthcare provider about your lipid panel results so you understand what they mean for you.

What does low HDL mean?

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

• Tangier disease. This genetic condition causes your HDL cholesterol to be too low.
• Familial combined hyperlipidemia. This genetic condition causes your HDL cholesterol to be too low and your LDL cholesterol to be too high.
• Metabolic syndrome. This is a combination of cardiovascular disease risk factors including lower than normal HDL levels.
• Overweight/obesity. Having extra weight 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.

What does it mean if I have high HDL?

An elevated, or abnormally high, HDL level is anything above 80 mg/dL.

One cause of elevated HDL is genetic mutations. Some mutations to your genes can cause your body to produce too much HDL cholesterol or have trouble getting rid of it. For example, a mutation to the CETP gene can cause your HDL to be higher than 150 mg/dL.

Other causes of abnormally high HDL can include:

• Hyperthyroidism.
• Primary biliary cholangitis.
• Alcohol use disorder.
• Certain medications.

Your healthcare provider will investigate the cause of your elevated HDL and tell you if you need treatment.

Lifestyle changes can help you raise your good cholesterol and lower your risk of cardiovascular disease.

How do I raise my HDL?

It’s best to talk to your healthcare provider for advice tailored to your specific needs and any medical conditions you might have. In general, certain lifestyle changes can help improve your HDL level. These include:

• Following a heart-healthy diet. Research supports the Mediterranean Diet as a way to improve your overall heart health, including your cholesterol numbers. With this diet, you’ll eat lots of fruits and veggies, legumes (beans and lentils) and whole grains. This diet also encourages you to eat foods rich in omega-3 fatty acids, which can raise your HDL cholesterol.
• Exercising. Aerobic exercise can help raise your HDL cholesterol. Aim for at least 30 minutes of exercise five or more days per week. If you haven’t exercised much in the past, it’s OK. Start with just five or 10 minutes per day, and gradually build up. But be sure to talk to your provider before starting any new exercise plan.
• Avoiding all tobacco use. Smoking, vaping and other tobacco products lower your HDL. So, if you don’t currently use tobacco, don’t start. And if you do, it’s important to work on stopping. Talk to your provider about strategies to help you quit. Secondhand smoke is also harmful. If you live with someone who smokes, offer your support to help them quit — both for their benefit and yours.

A note from Cleveland Clinic

Interpreting your cholesterol test results can be confusing. There are many terms to learn, and it can be hard to remember which cholesterol is “good” or “bad.” When it comes to HDL, remember “h” for “helpful.” HDL cholesterol is good because it helps move extra cholesterol out of your blood. Therefore, healthy levels of HDL can help lower your risk for heart disease.