All About HDL: The ‘Good’ Cholesterol in Your Body

The Biomarker Handbook is a curated series that seeks to provide readers with insights on each biomarker we cover in our blood test packages and its relation to our body.


Cholesterol is an essential type of fat (lipid) necessary for synthesising hormones and maintaining the proper function of tissues and organs in the body. Cholesterol is transported in the blood attached to proteins called lipoproteins. There are two main types of lipoproteins: LDL (low-density lipoprotein) also known as “bad cholesterol”, and HDL (high-density lipoprotein) also known as “good cholesterol.”

High LDL levels are related to a build-up of cholesterol in the arteries, leading to an increased risk of developing cardiovascular disease (CVD). High HDL levels are beneficial because this lipoprotein removes excess cholesterol from tissues and transports it to the liver to be discarded, decreasing the risk of CVD.

What’s the Importance of Tracking HDL Levels?

HDL test usually forms part of a lipid profile, which is used to screen for unhealthy levels of lipids (cholesterol and triglycerides) and to monitor response to treatment.

This works because HDL and LDL levels can be improved with the right lifestyle and dietary choices, lowering your risk for CVD.

In Asian population, it appears to be particularly common to have low HDL levels; therefore, the risk of CVD is heightened.

Who Should Get Tested? 

There is no golden rule as to how often to get tested, but it is clear that even those who seemingly have no risk factors for CVD should be checked– many of them are surprised to find that they have high cholesterol levels. When one or more risk factors for heart disease is present, the test should be ordered more frequently. Your doctor will help decide what is best for you. Risk factors for low HDL include:

– Being overweight or obese

– Physical inactivity

– Cigarette smoking

– Unbalanced diet

– More than 45 years of age in men

– More than 55 years of age in women

– High blood pressure

– Diabetes

– Family history of early heart disease

– Previously diagnosed heart disease

– Having had a previous heart attack

Is Any Preparation Needed Before Having a HDL Test?

In cases when this test is performed as part of a lipid profile, fasting for at least 9 to 12 hours is necessary. Only water is permitted before the test is performed.

If you are only going to get a HDL test, no fasting or any other preparations are needed.

What Are the Symptoms Related to a HDL Imbalance? 

Usually, a HDL imbalance does not produce any symptom. The only way to know if your levels are within normal ranges is by getting tested!

What Are Normal HDL Levels?

  • Optimal HDL levels are considered to be of 60 mg/dL (1.55 mmol/L) or higher, associated with a lower than average risk of heart disease.
  • Acceptable or normal HDL levels (associated with average risk of heart disease) are considered to be between 40 to 59 mg/dL (1.0 to 1.5 mmol/L)
  • Low HDL levels, which are related to an increased risk of heart disease, are less than 40 mg/dL (1.0 mmol/L)

Some laboratories include a report of the ratio of total cholesterol to HDL. To obtain this ratio, the total cholesterol is divided by the HDL level.

A desirable ratio is below 5 to 1 (where HDL makes up at least 20% of the total cholesterol), and the optimum ratio is below 3.5 to 1 (where HDL makes up at least 28% of the total cholesterol).

Normally, a healthcare provider will take into consideration the presence of all other CVD risk factors, including the HDL results, to help determine the overall heart disease risk.

The Consequences of Having Low HDL Levels?

When HDL levels are low, cholesterol cannot be removed from the tissues optimally, causing a fat build-up (plaque) in the blood vessels. This can eventually lead to atherosclerosis (hardening of the arteries) and decreased blood flow, which may result in cardiovascular events, such as heart attacks, stroke, and sudden death.

Ways to Balance These Levels 

Adopting healthy lifestyle habits can help achieve optimal HDL levels. This includes:

– Eating healthy: increase your good fats intake, such as avocado, nuts, and olive oil. Limit the intake of full-fat milk, lard, bacon, and other processed fatty foods or fried products

– Maintaining a healthy weight

– Exercising

– Refraining from smoking

– Avoiding alcohol consumption

Should your level of HDL persist below normal levels despite these efforts, your doctor may prescribe certain medications to help you, including statins, fibrates, or niacin.

 

Having adequate lipid levels helps maintain a healthy heart and lowers the risk of suffering from CVD, such as heart attack, stroke, or even death.

Therefore, it is of utmost importance to get routine medical check-ups, even if you consider yourself to be a healthy individual. Keep in mind that any person, of any age, can have unhealthy lipid levels– even children!


If you want to find out more about HDL and how to maintain healthy levels, take a look at our lifestyle article here!

Interested in other biomarkers? Check out the rest of The Biomarker Handbook.

For more information, drop us a message and we will get back to you.

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