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Biomarker library / Lipids

HDL cholesterol (HDL-C)

Also called high-density lipoprotein cholesterol, "good" cholesterol

The cholesterol carried in high-density lipoprotein particles, which move cholesterol from tissues back to the liver. It is measured directly on a standard lipid panel.

Written by the VitalDecades editorial team Reviewed by the editorial review process Updated

01  /  Reference ranges

What counts as normal

Scale in mg/dL. Cut points from the sources listed below.
Population Adults (ATP III)
Category Low (a major risk factor)
Range under 40 mg/dL
Source NCEP Adult Treatment Panel III, Executive Summary (NHLBI, 2001)

Effective

Population Adults (ATP III)
Category High (a negative risk factor)
Range 60 or higher mg/dL
Source NCEP Adult Treatment Panel III, Executive Summary (NHLBI, 2001)

Effective

Population Men, metabolic syndrome criterion (male)
Category Reduced HDL-C
Range under 40 mg/dL
Source AHA/NHLBI Scientific Statement: Diagnosis and Management of the Metabolic Syndrome (2005)

Effective

Population Women, metabolic syndrome criterion (female)
Category Reduced HDL-C
Range under 50 mg/dL
Source AHA/NHLBI Scientific Statement: Diagnosis and Management of the Metabolic Syndrome (2005)

Effective

Normal vs optimal

Higher is generally better as a marker, and 60 mg/dL or above is the ATP III "high" band. There is no guideline goal to raise HDL-C with medication. Very high HDL-C is not treated as protective beyond the reference range in current guidance.

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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 defines low HDL-C as under 40 mg/dL and counts 60 mg/dL or higher as a "negative" risk factor that removes one from the tally. The metabolic syndrome criteria in the 2005 AHA/NHLBI statement, still used in the 2018 AHA/ACC guideline's list of risk-enhancing factors, set the low cutoff by sex: under 40 mg/dL in men and under 50 mg/dL in women. Drug trials that raised HDL-C did not reduce events, so guidelines treat HDL-C as a risk marker rather than a treatment target.

03  /  In practice

Testing and what moves it

When it is tested

  • On every standard lipid panel.
  • Fasting is not required for HDL-C.

What raises it

  • Aerobic exercise, weight loss, stopping smoking, moderate alcohol (not recommended as a strategy), some genetics.

What lowers it

  • Insulin resistance and high triglycerides, smoking, inactivity, some medications (anabolic steroids, some beta blockers).

04  /  Related

Read next

Apolipoprotein B ApoBLDL cholesterol LDL-CTriglycerides TG

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 reduced heart attacks in trials, so guidelines do not set an HDL-C target.

Why is the low cutoff different for women? ▼

The AHA/NHLBI metabolic syndrome criteria set under 50 mg/dL for women and under 40 mg/dL for men because women's HDL-C runs higher on average; the same absolute value signals more risk in a woman.