HDL cholesterol

Blood test · no fasting needed

Also known as: HDL-C

There is no guideline goal for HDL cholesterol. A low level flags higher heart risk, but raising it with medicine has not been shown to help.

HDL cholesterol is the cholesterol carried in HDL particles. People with low HDL have more heart disease, which is why it is called the “good” cholesterol. But drugs that raise it have not cut heart attacks or deaths.

What it tells you

A standard cholesterol panel measures HDL directly. Non-HDL cholesterol is then worked out as total cholesterol minus HDL.
HDL is one of the inputs to the PREVENT equations, which US guidelines use to estimate heart risk.
The 2026 US cholesterol guideline sets no HDL goal. Its goals are for LDL cholesterol, non-HDL cholesterol and ApoB.
Low HDL, below 40 mg/dL in men or 50 mg/dL in women, is one of five signs used to define metabolic syndrome. It marks a cluster of risks, not a treatment goal.
Low HDL usually comes with high triglycerides, excess weight and insulin resistance.
The number does not show how well HDL particles work.

What can throw it off

Fasting does not change it.
Excess weight and insulin resistance lower it.
Regular exercise raises it slightly, by about 2 mg/dL on average.
Testosterone therapy in older men with low testosterone lowers it slightly.
Niacin, fibrates and some experimental drugs raise it, without cutting heart events.
After a heart attack, it shifts less than LDL cholesterol over the first few days.

Evidence

Predicting heart disease

Strong human evidenceCEBM Level 1a

In 302,430 people from 68 studies, each 15 mg/dL higher HDL went with about 22% lower heart disease risk, after other lipids were counted. The link held in fasting and non-fasting samples. It was weak for stroke.

Raising HDL with medicine

Tested: no benefit shownCEBM Level 1a

Across 39 trials in 117,411 patients, niacin, fibrates and similar drugs raised HDL but did not lower deaths or strokes. One HDL-raising drug increased heart events. Genetic studies agree that higher HDL alone does not lower risk.

Very high HDL

Strong human evidenceCEBM Level 1b

In 116,508 Danish adults, death rates were U-shaped. They were higher in men with HDL of 116 mg/dL or more and in women with 135 mg/dL or more. Very high HDL is not extra protection.

Limits

It is a marker, not a target. Raising the number with medicine has not lowered heart risk.
A high HDL does not offset a high LDL cholesterol, ApoB or Lp(a). Very high values went with more deaths in one large population.
It says little about stroke risk.
Much of what it predicts overlaps with triglycerides, weight and insulin resistance, so it is read with them.
It does not measure how well HDL works. Tests of HDL function are not standardized for routine care.

References

Reviewed by Shubham Gupta, MD — Founder & President · November 1, 2026

This page is for education only. It is not medical advice. Decisions about any treatment belong with a physician who knows your history.