HDL cholesterol 60 or higher mg/dL

Under ATP III an HDL of 60 mg/dL or higher "counts as a 'negative' risk factor; its presence removes one risk factor from the total count," and in the panel's Framingham scoring it subtracts a point. That is the whole of what this band does in a guideline: it lowers the risk tally that sets your LDL goal. It is a 2001 NHLBI classification and no ACC/AHA guideline since has re-issued a high-HDL band. The 2018, 2019 and 2026 guidelines mention HDL mainly as a risk-equation input and as the low-HDL half of the metabolic syndrome, so a high value earns no separate instruction in any of them.

What it does not license. No body sets an HDL goal, and none treats a high HDL as a reason to relax the rest of the profile. The 2026 guideline states its targets as LDL and non-HDL cholesterol only, and it keeps HDL inside the PREVENT risk calculation, where it is weighed together with total cholesterol, blood pressure, diabetes, tobacco use and kidney function. Drugs that push HDL up are not recommended: fibrates and niacin lack "proven reductions in ASCVD events when added to statin therapy." The 2018 guideline noted, for context, that Black adults have higher HDL on average than non-Hispanic White or Mexican American adults and that Asian Americans have lower levels.

Very high values, and what the evidence actually is. No guideline says a very high HDL is harmful. Two cohort studies, not guidelines, are the source of that idea. In the Copenhagen City Heart and General Population studies (52,268 men and 64,240 women), all-cause mortality was lowest at about 73 mg/dL in men and 93 in women and rose again at 97 or higher in men and 135 or higher in women; the women's 116 to 134 band was not statistically significant, and the authors wrote that the findings "need confirmation in other studies." A 2022 analysis of UK Biobank and Emory patients who already had coronary artery disease found an HDL over 80 mg/dL associated with roughly double the risk of death compared with 40 to 60, driven by men, with the women's result not significant. That study says nothing about healthy adults. Read together: a value in the 60s or 70s is the range ATP III rewards; a value far above that is a finding to mention to your clinician, not a diagnosis.

What to do. Nothing HDL-specific. Keep the screening interval the 2026 guideline sets, a lipid profile at least every 5 years from age 19, and judge the result by the numbers the guidelines actually target: LDL cholesterol, non-HDL cholesterol, and your calculated 10-year risk.