The test for high-density lipoprotein cholesterol (HDL-C) is used along with other lipid tests to screen for unhealthy levels of lipids and to determine the risk of developing heart disease.
HDL-C may also be monitored on a regular basis if previous test results have shown an increased risk for heart disease, if an individual has had a heart attack, or if someone is undergoing treatment for high cholesterol.
HDL-C may be ordered as a follow-up test to a high result on a cholesterol screening test. HDL-C is usually not ordered by itself but with other tests, including cholesterol, LDL cholesterol (LDL-C), and triglycerides as part of a lipid profile during a health checkup. It is recommended that all adults be tested at least once every five years.
HDL-C, as part of the lipid profile, may be ordered more frequently for those who have one or more risk factors for heart disease. Major risk factors include:
Age (men 45 years or older or women 55 years or older)
Hypertension (blood pressure of 140/90 or higher or taking high blood pressure medications)
Family history of premature heart disease (heart disease in an immediate family member—male relative under age 55 or female relative under age 65)
Pre-existing heart disease or already having had a heart attack
Screening with a lipid profile is recommended for children as well as adults. Children should be tested at least once between the ages of 9 and 11 and once again between the ages of 17 and 21. As with adults, additional testing may be required for young people with other risk factors or if screening shows that levels are above the accepted levels. Some of the risk factors include a family history of heart disease or health problems such as diabetes, high blood pressure, or being overweight. Doctors may order lipid profile screening for children under the age of 9 if a parent has high cholesterol, according to the American Academy of Pediatrics.
HDL-C levels may also be ordered at regular intervals to evaluate the success of lifestyle changes such as diet and exercise or smoking cessation aimed at increasing someone's level of HDL-C.
If HDL-C is less than 40 mg/dL (1.0 mmol/L) for men and less than 50 mg/dL (1.3 mmol/L) for women, there is an increased risk of heart disease that is independent of other risk factors, including the LDL-C level.
A typical level of HDL-C is between 40-50 mg/dL (1.0-1.3 mmol/L) for men and between 50-59 mg/dl (1.3-1.5 mmol/L) for women and is associated with average risk of heart disease.
Based on many epidemiologic studies, HDL-C of 60 mg/dL (1.55 mmol/L) or higher is associated with a less than average risk of heart disease. The National Cholesterol Education Panel Adult Treatment Guidelines suggest that an HDL cholesterol value greater than 60 mg/dL is protective and should be treated as a negative risk factor. However, some recent studies suggest that high HDL-C is not universally protective (See Common Questions #2).
For children, teens and young adults:
If HDL-C is less than 40 mg/dL (1.04 mmol/L), there is an increased risk of heart disease that is independent of other risk factors, including the LDL-C level.
A level of HDL-C between 40 and 45 mg/dL (1.04-1.17 mmol/L) is borderline.
A level of HDL-C greater than 45 mg/dL (1.17 mmol/L) is acceptable.
Some laboratories report a ratio of total cholesterol to HDL cholesterol. The ratio is obtained by dividing the total cholesterol by the HDL cholesterol. For example, if a person has a total cholesterol result of 200 mg/dL and an HDL cholesterol level of 50 mg/dL, the ratio would be stated as 4 (or 4:1). A desirable ratio is below 5 (5:1); the optimum ratio is 3.5 (3.5:1). The American Heart Association recommends that the absolute numbers for total blood cholesterol and HDL cholesterol levels be used because they are more useful than the ratio in determining appropriate treatment for patients.
HDL should be interpreted in the context of the overall findings from the lipid profile and in consultation with the health care provider.
A complete lipid profile requires fasting for 9-12 hours. If the testing occurs when a person is not fasting, only the HDL-C and total cholesterol values may be used for risk assessment.
HDL cholesterol should be measured when a person is not ill. Cholesterol is temporarily low during acute illness, immediately following a heart attack, or during stress (like from surgery or an accident). You should wait at least six weeks after any illness to have cholesterol measured.
In women, HDL cholesterol may change during pregnancy. Women should wait at least six weeks after having a baby to have HDL-C measured.
This article was last reviewed on August 26, 2013. | This article was last modified on December 29, 2014.
The review date indicates when the article was last reviewed from beginning to end to ensure that it reflects the most current science. A review may not require any modifications to the article, so the two dates may not always agree.
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