HDL Cholesterol
High-density lipoprotein, or "good"cholesterol
21 of 22 providers
Lipid Panel / Cardiovascular Health
Men:>40 mg/dL, Women:>50 mg/dL, Optimal:>60 mg/dL
What is HDL Cholesterol?
HDL Cholesterol (High-Density Lipoprotein Cholesterol) is often called "good cholesterol"because it transports cholesterol from peripheral tissues back to the liver for excretion—a process called reverse cholesterol transport. HDL particles also have anti-inflammatory, antioxidant, and anti-thrombotic properties that protect against atherosclerosis.
Normal HDL is >40 mg/dL in men and >50 mg/dL in women, with >60 mg/dL considered protective. Historically, HDL was thought to be causally protective—the higher the better. However, recent trials show raising HDL with medications (niacin, CETP inhibitors) does not reduce cardiovascular events, questioning HDL's causal role. The relationship may be more complex:HDL is a marker of metabolic health rather than a therapeutic target.
HDL functionality matters more than quantity. Dysfunctional HDL (from inflammation, diabetes, smoking) may paradoxically promote atherosclerosis despite normal or high levels. This explains why some people with high HDL still have heart disease, and why raising HDL with drugs failed to reduce events. HDL cholesterol efflux capacity (ability to remove cholesterol from macrophages) is a better predictor of cardiovascular risk than HDL level, though not widely available clinically.
Why HDL Is a Health Marker, Not a Treatment Target
- Reverse cholesterol transport:HDL removes cholesterol from arterial plaques and transports to liver for excretion
- Anti-inflammatory:HDL reduces inflammation in artery walls, inhibiting atherosclerosis progression
- Marker of health:High HDL reflects healthy lifestyle (exercise, lean body mass, Mediterranean diet) and absence of metabolic syndrome
- Not a treatment target:Raising HDL with medications doesn't reduce cardiovascular events. Focus on LDL lowering instead
- Gender difference:Women naturally have higher HDL (+10 mg/dL) than men due to estrogen. Same protective effect
- Very low HDL (<20 mg/dL):Associated with 2-3x higher cardiovascular risk and often indicates severe metabolic dysfunction
Optimal vs Standard Ranges
Protective>60 mg/dL▼
- Associated with reduced cardiovascular risk
- Each 1 mg/dL increase in HDL correlates with 2-3% lower cardiovascular risk in observational studies
- Reflects healthy lifestyle:regular exercise, lean body mass, Mediterranean diet, no smoking
Adequate40-60 mg/dL (men), 50-60 mg/dL (women)▼
- Acceptable range but not optimal
- Consider lifestyle interventions to raise HDL:aerobic exercise (most effective, raises HDL 3-9%), weight loss, smoking cessation, moderate alcohol (1-2 drinks daily raises HDL 3-5 mg/dL but also increases triglycerides)
Low (Increased CV Risk)<40 mg/dL (men), <50 mg/dL (women)▼
- Low HDL increases cardiovascular risk 50-100%
- Often part of metabolic syndrome with high triglycerides, abdominal obesity, insulin resistance
- Focus on weight loss, exercise, treating insulin resistance
- Medications to raise HDL (niacin, fibrates) don't reduce cardiovascular events—focus on lowering LDL instead
- If triglycerides >200 mg/dL, fibrate may help both
Very Low (High Risk)<20 mg/dL▼
- Very high cardiovascular risk (2-3x normal)
- Indicates severe metabolic dysfunction, often with diabetes, obesity, severe hypertriglyceridemia (>500 mg/dL)
- Requires aggressive lifestyle modification and LDL lowering
- Check for tangier disease (genetic HDL deficiency) if HDL <10 mg/dL
Scientific Evidence
HDL and Cardiovascular Risk - Observational Data
Framingham and other cohort studies show inverse relationship between HDL and cardiovascular risk. Each 1 mg/dL increase in HDL correlates with 2-3% lower cardiovascular risk. HDL <40 mg/dL in men and <50 mg/dL in women approximately doubles cardiovascular risk. However, this is association, not proven causation.
HDL-Raising Therapy Fails to Reduce Events
Multiple trials of HDL-raising therapies (niacin, CETP inhibitors) failed to reduce cardiovascular events despite successfully raising HDL 20-40%. AIM-HIGH, HPS2-THRIVE (niacin) and dal-OUTCOMES (dalcetrapib CETP inhibitor) all showed no benefit. This proved raising HDL pharmacologically doesn't reduce cardiovascular risk—HDL is a marker, not a target.
HDL Functionality vs Quantity
HDL cholesterol efflux capacity (ability to remove cholesterol from macrophages) predicts cardiovascular events independent of HDL level. Patients with high efflux capacity have lower risk even with low HDL, while those with low efflux have higher risk despite high HDL. This suggests HDL function is more important than quantity, but efflux testing is not widely available.
Exercise and HDL
Meta-analyses of exercise interventions show aerobic exercise raises HDL 3-9% (typically 2-8 mg/dL). Effect is dose-dependent—more exercise, greater HDL increase. Combination of aerobic and resistance training is most effective. HDL increase occurs within 3-4 months and requires ongoing exercise to maintain. This makes exercise the most effective HDL-raising intervention.
Source:Kodama S, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol:a meta-analysis. Arch Intern Med. 2007;167(10):999-1008.
Very Low HDL and Metabolic Syndrome
HDL <40 mg/dL is a component of metabolic syndrome and strongly associated with insulin resistance. Low HDL in metabolic syndrome reflects underlying metabolic dysfunction rather than being causal. Treatment focuses on weight loss, exercise, and treating insulin resistance (metformin, GLP-1 agonists) which secondarily raise HDL. Fibrates raise HDL but don't reduce cardiovascular events unless triglycerides >200 mg/dL.
Source:Grundy SM, et al. Diagnosis and management of the metabolic syndrome:an AHA/NHLBI scientific statement. Circulation. 2005;112(17):2735-2752.
Which Providers Test HDL Cholesterol?
Full Provider Comparison
| Provider | Includes | Annual Cost | Biomarkers |
|---|---|---|---|
 Superpower | ✓ | $199 | 100+ (150 with ratios) |
 WHOOP Advanced Labs | ✓ | $349 | 65 |
 Labcorp OnDemand | ✓ | $398 | 30+ |
| ✓ | $486 | 40+ | |
| ✓ | $444 | 288 | |
| ✓ | $349 | 100+ | |
| ✓ | $761 | 54 | |
 Function Health | ✓ | $365 | 160+ |
| ✓ | $250 | 65 | |
| ✓ | $495 | 70+ | |
| ✓ | $895 | 100+ | |
| ✓ | $1950 | 150+ | |
| ✓ | $375 | 80+ | |
| — | $Varies | 75+ | |
| ✓ | $190 | 100+ | |
| ✓ | $99 | 50 | |
| ✓ | $124 | 60 | |
| ✓ | $199 | 50 | |
| ✓ | $499 | 120+ | |
| ✓ | $4188 | 70-80+ | |
| ✓ | $375 | 85 | |
| ✓ | $700 | 128 |
Frequently Asked Questions
What is HDL Cholesterol?
High-density lipoprotein, or "good"cholesterol
What is the optimal range for HDL Cholesterol?
The standard reference range for HDL Cholesterol is Men:>40 mg/dL, Women:>50 mg/dL, Optimal:>60 mg/dL. Optimal ranges may differ based on individual health goals and expert recommendations.
Which blood test providers include HDL Cholesterol?
21 out of 22 blood testing providers include HDL Cholesterol in their panels. This biomarker is widely available across major providers.
What category does HDL Cholesterol fall under?
HDL Cholesterol is categorized under Lipid Panel / Cardiovascular Health. This category includes biomarkers that help assess related aspects of health and wellness.
Medical Disclaimer
This information is for educational purposes only and is not medical advice. Always consult with a qualified healthcare provider about your specific health needs.
Last reviewed:2026-02-20