HDL cholesterol: healthy levels and what low HDL means

What HDL cholesterol is

HDL stands for high-density lipoprotein. Lipoproteins are a mix of fat and protein that carry cholesterol through the blood. HDL carries cholesterol from other parts of the body back to the liver, which removes it from the body (MedlinePlus HDL). The National Heart, Lung, and Blood Institute (NHLBI) says HDL carries cholesterol and plaque to the liver to be flushed out of the body, and that high levels of HDL may lower your risk for health problems (NHLBI).

LDL, low-density lipoprotein, is the "bad" cholesterol: a high LDL level leads to a buildup of cholesterol in your arteries (MedlinePlus HDL).

HDL cholesterol levels chart

HDL is measured in milligrams per deciliter (mg/dL) on a lipid panel. With HDL, higher numbers are better (MedlinePlus HDL). MedlinePlus, from the US National Library of Medicine, prints these levels:

Sources: MedlinePlus HDL page (MedlinePlus HDL) and MedlinePlus cholesterol levels test page (MedlinePlus). The NHLBI describes a healthy lipid profile as non-HDL cholesterol below 130 mg/dL with an HDL of at least 40 mg/dL for men and 50 mg/dL for women, and says to check with your provider on the levels that are best for you (NHLBI diagnosis).

For the other numbers on the same panel, see cholesterol levels by age and triglycerides.

How HDL fits into heart risk

A high HDL level can lower your risk for coronary artery disease and stroke (MedlinePlus HDL). In general, low LDL and high HDL levels are good for heart health (MedlinePlus). HDL is not the whole story, though. The NHLBI notes a study that found higher HDL may not be as beneficial in some Black and White adults as was once believed, and other risk factors, such as high blood pressure, obesity or diabetes, may outweigh the benefits of higher HDL (NHLBI causes).

That is why heart risk tools use HDL together with total cholesterol, blood pressure, diabetes, smoking and age. Try the heart risk calculator, estimate LDL with the LDL calculator, or compare triglycerides with HDL in the triglyceride to HDL ratio calculator.

What lowers HDL

An unhealthy lifestyle is the most common cause of low HDL. Genes, other medical conditions and some medicines can also lower it (NHLBI causes). The NHLBI lists:

• Smoking: lowers HDL, particularly in women, and raises LDL (NHLBI causes). Secondhand smoke can also lower HDL (MedlinePlus HDL).
• Some medicines: for example amiodarone for heart rhythm problems and beta-blockers for angina or high blood pressure, among others (NHLBI causes).
• Menopause: after menopause, women's HDL usually goes down while total and LDL cholesterol go up (NHLBI causes).
• Background: Hispanic Americans are more likely to have lower HDL than other groups, and African Americans are more likely to have high HDL (NHLBI causes).

How to raise a low HDL

If your HDL is too low, lifestyle changes may help (MedlinePlus HDL):

• Eat good fats instead of bad fats. Limit saturated fats, avoid trans fats, choose unsaturated fats such as avocado, olive oil and nuts, limit carbohydrates, especially sugar, and eat more high-fiber foods such as oatmeal and beans.
• Stay at a healthy weight. Losing weight can boost HDL, especially if you carry a lot of fat around your waist.
• Exercise. Aim for 30 minutes of moderate to vigorous aerobic exercise on most, if not all, days.
• Avoid cigarettes and secondhand smoke.
• Limit alcohol. Too much alcohol can make you gain weight, which lowers HDL.

Some cholesterol medicines, including certain statins, can also raise HDL (MedlinePlus HDL). Talk to your provider before making any major change in your diet or exercise routine (MedlinePlus).

How often to check

MedlinePlus gives these general recommendations: for people 19 or younger, the first test between ages 9 and 11 and then every 5 years, or from age 2 with a family history of high cholesterol, heart attack or stroke. For adults, younger adults every 5 years, and men aged 45 to 65 and women aged 55 to 65 every 1 to 2 years (MedlinePlus HDL).

Common questions

Is a high HDL always good?

Higher HDL is generally better (MedlinePlus HDL), but the NHLBI notes it may not be as protective for everyone as once believed, and other risk factors can outweigh it (NHLBI causes). Your provider looks at your whole lipid panel and risk factors.

What is non-HDL cholesterol?

Total cholesterol minus HDL cholesterol. The NHLBI healthy lipid profile has non-HDL below 130 mg/dL (NHLBI diagnosis).

Why do the sources word the cut-offs a little differently?

The MedlinePlus HDL page says "more than" 40 or 50 mg/dL, while its lab test page calls levels "less than" 40 or 50 mg/dL low, and the NHLBI says "at least" 40 or 50 mg/dL (MedlinePlus HDL) (MedlinePlus) (NHLBI diagnosis). We print each one as written. A result right at the line is one to discuss with your provider.