01 / Reference ranges
What counts as normal
Normal vs optimal
Higher reads as lower risk across the usual range, and 60 mg/dL or above is the ATP III "high" band. No guideline sets a goal to raise HDL-C, with lifestyle or with medication. No guideline addresses very high HDL-C at all; the idea that it stops being protective comes from two cohort studies, described on the high-HDL band page with their limits.
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02 / Why it matters
What the number tells you
Low HDL-C tracks with higher cardiovascular risk and with insulin resistance. NCEP ATP III (2001) calls it "a strong independent predictor of CHD," defines low as under 40 mg/dL, and counts 60 mg/dL or higher as a "negative" risk factor that removes one from the tally. ATP III's metabolic syndrome criteria, whose HDL cutoffs the 2018 and 2019 ACC/AHA guidelines print unchanged, set the low cutoff by sex: under 40 mg/dL in men and under 50 mg/dL in women. The 2026 ACC/AHA dyslipidemia guideline, which retired the 2018 guideline, sets no HDL goal and says fibrates and niacin are not recommended "due to lack of proven reductions in ASCVD events when added to statin therapy," so HDL-C is a risk marker and an input to the PREVENT risk equations, not a treatment target.
03 / In practice
Testing and what moves it
When it is tested
- On every standard lipid panel. The 2026 ACC/AHA guideline recommends a lipid profile from age 19 at least every 5 years, more often with additional risk factors.
- Fasting is not required for HDL-C; the 2026 guideline says nonfasting samples can be used for most people.
What raises it
- Regular physical activity: ATP III says it "raises HDL cholesterol," and the 2026 guideline cites a meta-analysis of 148 trials with an average rise of 2.11 mg/dL.
- Weight reduction, which ATP III names with physical activity as first-line therapy when the metabolic syndrome is present.
- A higher share of total fat, mostly unsaturated, within ATP III's allowed 25 to 35 percent of calories, which ATP III says "can help to reduce triglycerides and raise HDL cholesterol in persons with the metabolic syndrome."
- Drugs move the lab value (ATP III Table 7: statins 5 to 15 percent, fibrates 10 to 20 percent, niacin 15 to 35 percent) without proven benefit from the HDL change, and the 2026 guideline does not recommend fibrates or niacin for it.
What lowers it
- The insulin-resistance cluster ATP III lists: elevated triglycerides, overweight and obesity, physical inactivity, type 2 diabetes.
- Cigarette smoking and a diet over 60 percent carbohydrate (ATP III).
- Beta-blockers, anabolic steroids, progestational agents and corticosteroids (ATP III).
04 / Related
Read next
Frequently asked questions
Is a high HDL always good?
Higher HDL-C is associated with lower risk across the usual range, and 60 mg/dL or above counts as a negative risk factor under ATP III. Raising it with drugs has not been shown to cut events: the 2026 ACC/AHA guideline does not recommend fibrates or niacin for that purpose, and no guideline sets an HDL-C target.
Why is the low cutoff different for women?
ATP III's metabolic syndrome criteria set under 50 mg/dL for women and under 40 mg/dL for men, and the 2018 and 2019 ACC/AHA guidelines print the same numbers. None of those documents states the reason for the difference; they print the cutoffs and stop, so we do not supply a reason either.
One document sets the numbers on this page, published in 2001.
We last re-read these sources on . How we verify.