HDL Cholesterol

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Also known as: HDL; HDL-C
Formal name: High-density Lipoprotein Cholesterol

At a Glance

Why Get Tested?

To determine risk of developing heart disease

When to Get Tested?

As part of a regular health exam with a cholesterol test or lipid profile; at least once every five years in adults; children should have a lipid profile screening at least once between the ages of 9 and 11 and then again between the ages of 17 and 21.

Sample Required?

A blood sample drawn from a vein in your arm or from a fingerstick

Test Preparation Needed?

If this test is to be performed as part of a complete lipid profile, fasting for 9-12 hours typically will be required; only water is permitted. Follow any instructions you are given.

The Test Sample

What is being tested?

High-density lipoprotein (HDL cholesterol, HDL-C) is one of the classes of lipoproteins that carry cholesterol in the blood. HDL-C consists primarily of protein with a small amount of cholesterol. It is considered to be beneficial because it removes excess cholesterol from tissues and carries it to the liver for disposal. Hence, HDL cholesterol is often termed "good" cholesterol. The test for HDL cholesterol measures the amount of HDL-C in blood.

High levels of cholesterol have been shown to be associated with the development of hardening of the arteries (atherosclerosis) and heart disease. When cholesterol levels in the blood increase (not enough is removed by HDL), it may be deposited on the walls of blood vessels. These deposits, termed plaques, can build up, causing vessel walls to become more rigid, and may eventually narrow the openings of blood vessels, constricting the flow of blood.

A higher level of blood HDL-C can decrease the risk of developing plaques by removing excess cholesterol from the blood and lower the risk of heart attack or stroke.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm. Sometimes a drop of blood is collected by puncturing the skin on a fingertip. This fingerstick sample is typically used when HDL-C is being measured on a portable testing device, for example, at a health fair.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

Since this test is usually performed as part of a complete lipid profile, fasting for 9-12 hours before sample collection is typically required; only water is permitted. Follow any instructions you are given.

The Test

Common Questions

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Sep 2002. PDF available for download at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf through http://www.nhlbi.nih.gov. Accessed July 21, 2013.

(December 2011) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics. December 2011. Vol 128. Supplement 5. PDF available for download at http://pediatrics.aappublications.org/site/misc/2009-2107.pdf through http://pediatrics.aappublications.org. Accessed July 21, 2013.

(©2012) American Heart Association. Cholesterol Levels. Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/Cholesterol_UCM_001089_SubHomePage.jsp through http://www.heart.org. Accessed July 21, 2013.

(November 2012) American Association of Family Physicians. High Cholesterol. Available online at http://familydoctor.org/familydoctor/en/diseases-conditions/high-cholesterol.html through http://familydoctor.org. Accessed July 19, 2013.

Voight, B.F. et al. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. The Lancet. August 2012. Vol 380. Issue 9841. Available online at: http://www.sciencedirect.com/science/article/pii/S0140673612603122 through http://www.sciencedirect.com. Accessed July 2013.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

American Heart Association. "What are healthy levels of cholesterol?" Article available online at http://216.185.112.5/presenter.jhtml?identifier=183

National Heart, Lung, Blood Institute. National Cholesterol Education Program Guidelines, Cholesterol, ATP III. Pp 31-34. PDF available for download at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf through http://www.nhlbi.nih.gov. Accessed July 2008.

Pagana K, Pagana T. Mosby's Manual of Diagnostic and Laboratory Tests. 3rd Edition, St. Louis: Mosby Elsevier; 2006. pp 351-355.

MayoClinic.com. Cholesterol Levels, What numbers should you aim for? (June 21, 2008). Available online at http://www.mayoclinic.com/health/cholesterol-levels/CL00001 through http://www.mayoclinic.com. Accessed July 2008.

American Heart Association. What Your Cholesterol Level Means. (April 7, 2008). Previously available online at http://216.185.112.5/presenter.jhtml?identifier=183#HDL. Accessed July 2008.

Clarke, W. and Dufour, D. R., Editors (2006). Contemporary Practice in Clinical Chemistry, AACC Press, Washington, DC. Pp 252-253.

Ken-ichi Hirano, et al. Atherosclerotic Disease in Marked Hyperalphalipoproteinemia: Combined Reduction of Cholesteryl Ester Transfer Protein and Hepatic Triglyceride Lipase. Arteriosclerosis, Thrombosis, and Vascular Biology. 1995;15:1849-1856. Available online at http://atvb.ahajournals.org/cgi/content/full/atvbaha;15/11/1849?eaf through http://atvb.ahajournals.org. Accessed May 2010.

MedWire News: Dangerous edge to very high HDL-C levels. J Am Coll Cardiol 2008; 51: 634-642. Available online at http://www.lipidsonline.org/news/article.cfm?aid=5936 through http://www.lipidsonline.org. Accessed May 2010.

Lia Tremblay (LifeWire). Are High HDL Levels the Answer to Cholesterol Problems? Why High HDL Levels May Not Be Good Enough. Available online at http://cholesterol.about.com/lw/Health-Medicine/Conditions-and-diseases/Is-Increasing-HDL-Levels-the-Answer-to-Cholesterol-Problems-.htm through http://cholesterol.about.com. Accessed May 2010.