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HDL cholesterol A marker of heart risk, not a target

Also called High-density lipoprotein cholesterol, HDL-C and “Good” cholesterol Often on a standard checkup No fasting needed

The short answer

HDL cholesterol is the “good” cholesterol on your report. A level under 40 mg/dL for men, or 50 for women, is a sign of higher heart risk.2,3 But it’s a marker, not a target: medicines that raise it haven’t prevented heart attacks.5

A good result
40 mg/dL or higher for men, and 50 or higher for women.2 Higher isn’t always better. Above about 90, it stops lowering your risk.3
If yours is low
Look at what usually comes with it, such as high triglycerides, insulin resistance, extra weight, smoking or too little exercise.1,3 Pills that raise HDL don’t prevent heart attacks.5
Should you test?
You probably already have. It’s on every standard cholesterol test, and clinicians use it to estimate your heart risk.1

Check your result

Type the number from your report. It stays on this page.

Which applies to you?
40 90
  • Low Under 40
  • Typical 40 to 89
  • Very high 90 or more

Enter your result to see what it means and what to do next.

Got a result from another lab? Ask Picardo about it. The app explains your results, and a physician can follow up.

The cutoffs for low are the ones used to define metabolic syndrome.2 The 90 line is where heart risk stops falling as HDL rises.3 US guidelines set no target for HDL.1 The bar isn’t to scale.

What is a normal HDL cholesterol level?

Under 40 mg/dL is low for men, and under 50 for women.2 Your report may use 40 as the cutoff for everyone, so a woman’s result of 40 to 49 can go unflagged. At the other end, HDL stops lowering heart risk above about 90:3

Low Under 40 mg/dL for men; under 50 for women

Low: a reason to look at the rest

Low HDL goes with higher heart risk, mostly because of what tends to come with it: high triglycerides and the particles that carry them, which do build plaque.3 It’s one of the five signs of metabolic syndrome.2

How worried to be

Not urgent. It’s a prompt to check your other numbers, not a number to chase.

What to do next
  1. 1 Check ApoB and HbA1c. With high triglycerides or diabetes, ApoB shows plaque-building particles that LDL cholesterol can miss.1
  2. 2 If you smoke, stopping does the most good. Moving more and losing extra weight help too; see the options below.1,8
  3. 3 Skip niacin and supplements meant to raise HDL. They don’t prevent heart attacks.1,5
Typical 40 to 89 mg/dL for men; 50 to 89 for women

In the usual range

Your HDL isn’t adding to your risk. It doesn’t cancel out other risks, though: clinicians weigh it alongside total cholesterol, blood pressure, blood sugar, smoking and kidney function, and treat to goals for LDL and non-HDL cholesterol.1

How worried to be

Nothing to worry about.

What to do next
  1. 1 Look at your LDL or non-HDL cholesterol. Those are the numbers treatment aims at.1
  2. 2 If you’ve never had Lp(a) checked, do it once. US guidelines now recommend it for every adult.1
Very high 90 mg/dL or higher

Very high: no extra protection

Above about 90, a higher HDL doesn’t lower heart risk any further.3 At the very top it may even track with higher risk. In a Danish study of 116,000 people, men with HDL of 97 or more and women with 135 or more had higher death rates than those in the middle.6 Among people with heart disease, HDL over 80 went with more deaths from heart disease.7

How worried to be

Not a worry on its own. These are links seen in studies, not proof that high HDL causes harm.3

What to do next
  1. 1 Judge your heart risk on the rest, such as LDL cholesterol or ApoB, blood pressure, blood sugar and smoking.1
  2. 2 If you drink heavily, cut back. Heavy drinking can push HDL very high.3
Heart Health panel
$150.90 · HDL cholesterol plus 16 more tests, one visit
Order
Or order just the lipid panel, $4.50

What is HDL cholesterol?

Picture HDL as a fleet of ferries carrying spare cholesterol back to your liver. The HDL number tells you how much cholesterol is on board, not how well the ferries are working, which is one reason it makes a poor target.3

HDL particles collect spare cholesterol from cells, including cells in artery walls, and take it to the liver to be cleared. The HDL on your cholesterol test is the cholesterol inside them.3

Is HDL really the “good” cholesterol?

It earned the name because people with more HDL have fewer heart attacks.3 But the evidence says the cholesterol in HDL isn’t what protects them:

  • A review of 39 trials with 117,411 people found that niacin, fibrates and CETP inhibitors all raised HDL. None cut deaths, heart attacks or strokes in people taking a statin.5 One later CETP inhibitor, anacetrapib, did cut events slightly, in step with how much it lowered non-HDL cholesterol.3
  • A gene variant that raises HDL by about 5 mg/dL should have cut heart attack risk by about 13%. In a study of 116,000 people, carriers had the same risk as everyone else. Gene variants that raise LDL cholesterol raised risk, as expected.4
  • Low HDL mostly reflects high triglycerides and the particles that carry them, and those particles do build plaque.3

So HDL is a marker, not a target. US guidelines use it to estimate your heart risk, then set treatment goals for LDL and non-HDL cholesterol instead.1

What lowers HDL?

Low HDL is usually part of a wider pattern:

  • High triglycerides, insulin resistance and type 2 diabetes1,3
  • Extra weight, especially around the waist1
  • Smoking9
  • Too little exercise1
  • Your genes, including some rare inherited conditions3

Should you try to raise HDL?

Not for its own sake. What’s worth doing is tackling what usually drags it down, because that lowers your heart risk whatever happens to the number. These options are rated by what they do for your heart, not for your HDL.

  • Quitting smoking

    In a trial, people who quit gained about 2 mg/dL of HDL within a year, even as they put on weight.9 Far more important, heavy smokers who quit had about 40% lower risk of heart attack, stroke or heart failure over the next five years than those who kept smoking.8

    How much it helps
    A lot
    How sure we are
    Very sure
  • Regular exercise

    Across 148 trials, exercise training raised HDL by about 2 mg/dL and lowered LDL by about 7 and triglycerides by about 8. Being active also lowers the chance of dying from heart disease.1

    How much it helps
    Some
    How sure we are
    Fairly sure
  • Losing extra weight

    Triglycerides fall by about 4 mg/dL for every kilogram you lose, and other heart risk factors improve with them.1

    How much it helps
    Some
    How sure we are
    Fairly sure

Skip niacin. It raises HDL, but on top of a statin it didn’t prevent heart attacks or strokes, and US guidelines advise against it.1,5

Expect HDL itself to move only a few mg/dL.1,9 If you’re treated for cholesterol, your clinician will track LDL and non-HDL cholesterol, not HDL.1

Who should get an HDL test?

Almost every adult. HDL is part of the standard cholesterol test that US guidelines recommend for nearly all adults. It’s also one of the numbers in PREVENT, the calculator clinicians use to estimate your 10-year heart risk.1

A low result is a reason to look further, especially if:

  • Your triglycerides are 150 mg/dL or higher, or you have diabetes. Here ApoB shows plaque-building particles that LDL cholesterol can underestimate.1
  • Your waist is large or your blood sugar is creeping up. Low HDL is one of five signs of metabolic syndrome, along with waist size, triglycerides, blood pressure and fasting glucose.2

Read the ApoB guide

How to get an HDL cholesterol test, and what it costs

It comes from the lipid panel, which costs $4.50 through Picardo. The Heart Health panel adds 16 more tests from the same visit for $150.90.

Recommended

Heart Health panel

$150.90
17 tests · fast for 12 hours first

The panel reports HDL too, and adds ApoB, ApoA-1 and Lp(a), plus HbA1c and insulin for the insulin resistance that often comes with low HDL.[1] See what’s in it

Order the Heart Health panel
Just this test

Lipid panel

$4.50
Labcorp 303756 · no fasting needed

The test this number comes from.

Order the lipid panel
  • Results in 2 to 3 days, in the app
  • Physician follow-up if you want one
  • Free Labcorp draw, or $75 at home
  • No other fees. HSA and FSA eligible.

It’s also part of the Base Core Annual – Men, Base Core Annual – Women and Postpartum panels, if you want a wider checkup.

Already have a result? Ask Picardo about it

Questions people ask

Do I need to fast for an HDL test?

No. US guidelines say a cholesterol test without fasting works for most adults.1 Your clinician may ask you to fast if they’re checking for high triglycerides.1

What is non-HDL cholesterol?

Your total cholesterol minus your HDL. It’s the cholesterol in every particle that can build plaque, and US guidelines now set treatment goals for it, alongside LDL cholesterol.1

Is low HDL genetic?

Sometimes. Rare changes in a few genes, including APOA1, ABCA1 and LCAT, cause very low HDL. In large population studies these changes didn’t raise heart risk, though some affected families do have more heart disease.3

Does alcohol raise HDL?

Heavy drinking can push HDL very high, but that isn’t protection. It may be one reason the highest HDL levels go with higher death rates, not lower ones.3

Should women have higher HDL than men?

The cutoff for low is higher for women, at 50 mg/dL against 40 for men.2 In a large Danish study, the HDL level with the lowest death rate was higher for women too, about 93 against 73 for men.6

Often checked alongside

ApoA-1
The main protein on HDL particles
Triglycerides
Blood fats that rise with sugar and alcohol
LDL cholesterol
The main cholesterol behind plaque
Non-HDL cholesterol
The cholesterol in every plaque-building particle

Test details

Labcorp test
Lipid Panel, 303756
LOINC
2085-9
Sample
Blood
Fasting
Not needed1
Typical lab range
40 mg/dL or higher
Units
mg/dL in the US. For mmol/L, divide by 38.6.1

Sources

  1. 1 Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia. Circulation. 2026;153(17):e1154–e1276. doi.org/10.1161/CIR.0000000000001423
  2. 2 Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–1645. doi.org/10.1161/CIRCULATIONAHA.109.192644
  3. 3 von Eckardstein A, Nordestgaard BG, Remaley AT, Catapano AL. High-density lipoprotein revisited: biological functions and clinical relevance. Eur Heart J. 2023;44(16):1394–1407. doi.org/10.1093/eurheartj/ehac605
  4. 4 Voight BF, Peloso GM, Orho-Melander M, et al. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. Lancet. 2012;380(9841):572–580. doi.org/10.1016/S0140-6736(12)60312-2
  5. 5 Keene D, Price C, Shun-Shin MJ, Francis DP. Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117,411 patients. BMJ. 2014;349:g4379. doi.org/10.1136/bmj.g4379
  6. 6 Madsen CM, Varbo A, Nordestgaard BG. Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies. Eur Heart J. 2017;38(32):2478–2486. doi.org/10.1093/eurheartj/ehx163
  7. 7 Liu C, Dhindsa D, Almuwaqqat Z, et al. Association between high-density lipoprotein cholesterol levels and adverse cardiovascular outcomes in high-risk populations. JAMA Cardiol. 2022;7(7):672–680. doi.org/10.1001/jamacardio.2022.0912
  8. 8 Duncan MS, Freiberg MS, Greevy RA, et al. Association of smoking cessation with subsequent risk of cardiovascular disease. JAMA. 2019;322(7):642–650. doi.org/10.1001/jama.2019.10298
  9. 9 Gepner AD, Piper ME, Johnson HM, et al. Effects of smoking and smoking cessation on lipids and lipoproteins: outcomes from a randomized clinical trial. Am Heart J. 2011;161(1):145–151. doi.org/10.1016/j.ahj.2010.09.023

Updated 28 Oct 2026.

This is general health information, not medical advice: talk to your clinician about your results and before changing any treatment.