LabCorp and its Specialty Testing Group, a fully integrated portfolio of specialty and esoteric testing laboratories.
To determine your risk of developing heart disease
Screening: as part of a regular health exam with a lipid panel when no risk factors for heart disease are present; once every four to six years in adults; youth should have a lipid panel at least once between the ages of 9 and 11 and then again between the ages of 17 and 21.
Monitoring: may be done more frequently and at regular intervals as part of a lipid panel when risk factors for heart disease are present, when prior results showed high risk levels, and/or when undergoing treatment for unhealthy lipid levels
A blood sample is drawn from a vein in your arm. Sometimes a drop of blood is collected by puncturing the skin on a fingertip. This fingerstick sample is typically used when a lipid panel is being measured on a portable testing device, for example, at a health fair.
If this test is to be performed as part of a complete lipid panel, fasting for 9 to 12 hours typically will be required (drinking only water), but some healthcare practitioners allow non-fasting lipid panel testing. In particular, children, teens and young adults may have testing done without fasting. Follow any instructions you are given and tell the person drawing your blood whether you have fasted.
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 removal. HDL cholesterol is often called "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 and not enough is removed by HDL, it may be deposited in the walls of blood vessels. These deposits, called 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 is usually associated with a lower risk of developing plaques, lowering the risk of heart attack or stroke.
The test for high-density lipoprotein cholesterol (HDL-C) is used as part of a lipid panel to screen for unhealthy levels of lipids and to determine your risk of developing heart disease and help make decisions about what treatment to use if you have borderline risk, intermediate risk, or high risk. The other components of a lipid panel typically include total cholesterol, LDL cholesterol (LDL-C), and triglycerides.
The results of the lipid panel are considered along with other known risk factors of heart disease to develop a plan of treatment and follow up. Depending on the results and other risk factors, treatment options may involve lifestyle changes such as diet, cessation of smoking or alcohol, and exercise or medications that lower lipid levels, typically statins.
As part of a lipid panel, HDL-C may also be used to monitor whether treatment has been effective in lowering cholesterol levels.
HDL-C may be ordered as part of a lipid panel during a health checkup. It is recommended that all adults with no risk factors for heart disease be tested every four to six years.
If you have risk factors or if previous testing showed that you had a high cholesterol level, more frequent testing with a full lipid panel is recommended. Major risk factors include:
Children, teens and young adults (ages 2 to 24 years old) with no risk factors should be tested at least once between the ages of 9 and 11 and once again between the ages of 17 and 21, according to the American Academy of Pediatrics.
Youths with an increased risk of heart disease as adults should have earlier and more frequent screening with lipid panels. Some of the risk factors are like those in adults and include a family history of heart disease or health problems such as diabetes, high blood pressure, or being overweight. High-risk children should have a fasting lipid panel between the ages of 2 and 8. Children younger than 2 years old are too young to be tested.
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.
In general, healthy lipid levels help to maintain a healthy cardiovascular system and lower the risk of heart attack or stroke. Your healthcare practitioner will take into consideration the results of the HDL-C and the other components of a lipid panel as well as other risk factors to help determine your overall risk of heart disease, whether treatment is necessary and, if so, which treatment will best help to lower your risk of heart disease.
Health organizations have different recommendations for the treatment based on your predicted cardiovascular disease (CVD) risk (which is based on your age, weight, blood pressure, whether you smoke or have diabetes, and other factors).
If you are age 40 to 75 and do not have heart disease, current guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend that a risk calculator be used to determine your 10-year risk of CVD. Many factors are considered in the calculation, including total cholesterol, LDL-C, HDL-C, age, gender, race, blood pressure, diabetes, and smoking. The U.S. Preventive Services Task Force (USPSTF) makes similar recommendations. For more details, see the Lipid Panel article.
However, use of the risk calculator and ACC/AHA guidelines remain controversial and are evolving as more data become available. Many still use the older guidelines (2002) from the NCEP Adult Treatment Panel (ATP) III to evaluate HDL-C levels and heart disease risk as summarized below:
|Low Level, Increased Risk||Average Level, Average Risk||High Level, Less than Average Risk|
|Women||Less than 50 mg/dL (1.3 mmol/L)||50-59 mg/dL (1.3-1.5 mmol/L)||60 mg/dL (1.55 mmol/L) or higher|
|Men||Less than 40 mg/dL (1.0 mmol/L)||40-50 mg/dL (1.0-1.3 mmol/L)||60 mg/dL (1.55 mmol/L) or higher|
Note: Although high HDL-C is considered to be beneficial, a study published in 2018 by the European Society of Cardiology showed that very high levels of HDL cholesterol may also be associated with an increased risk of heart attack and death.
For children, teens and young adults:
|Acceptable||45 mg/dL (1.17 mmol/L) or higher|
|Borderline||40-45 mg/dL (1.04-1.17 mmol/L)|
|Low Level, Increased Risk||Less than 40 mg/dL (1.04 mmol/L)|
Some laboratories report a ratio of total cholesterol to HDL cholesterol (cholesterol ratio). The ratio is obtained by dividing the total cholesterol by the HDL cholesterol. For example, if you have 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.
Low HDL-C is not usually a target for treatment with medication. While some drugs used to lower LDL-C can also raise HDL-C, these drugs are not typically prescribed based on HDL-C levels. Certain lifestyle changes, however, may be recommended to help increase your HDL-C level. Since smoking can decrease HDL-C levels, quitting smoking (if you are a smoker) is a good way to increase HDL-C. Exercise is another good way to increase HDL-C.
High HDL-C has generally been found to be protective, decreasing the risk of coronary artery disease (CAD) in most people. However, some recent studies have shown that in some people with high HDL-C, the HDL-C is not protective and may, in fact, result in higher risk for CAD than in people with normal HDL-C levels. In one study, it was shown that people with CAD and high HDL-C had underlying genetic anomalies in enzymes important in lipid turnover (cholesterol ester transfer protein and hepatic triglyceride lipase). Another study showed that high levels of abnormally large HDL-C particles were associated with an increased risk of CAD. Further research is needed to determine what conditions contribute to an unexpectedly high risk of CAD in the presence of high HDL-C.
HDL cholesterol should be measured when you are 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 delivery to have their HDL-C measured.
Sources Used in Current Review
Grundy, Scott M., Stone NJ, Bailey AL, et al. (2018 November 10) 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. Available online at https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625. Accessed November 2019.
Nordestgaard, Børge G., Langsted, Anne, Mora, Samia, et al. (2016 July 1). Fasting Is Not Routinely Required for Determination of a Lipid Profile: Clinical and Laboratory Implications Including Flagging at Desirable Concentration Cut-points—a Joint Consensus Statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. European Heart Journal. Available online at https://doi.org/10.1093/eurheartj/ehw152. Accessed November 2019.
(7 September 2018 Updated) How and When to Have Your Cholesterol Checked. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/features/cholesterol-screenings/index.html. Accessed November 2019.
Yang, Eric H (2018 November 30, Updated) Lipid Management Guidelines. Medscape. Available online at https://emedicine.medscape.com/article/2500032-overview. Accessed November 2019.
Allard-Ratick, M, Khambhati, J., Topel, M, et al. (2018 August). Elevated HDL-C Is Associated With Adverse Cardiovascular Outcomes. European Society of Cardiology. Available online at https://esc365.escardio.org/Congress/ESC-Congress-2018/HDL-cholesterol-A-moving-target/174943-elevated-hdl-c-is-associated-with-adverse-cardiovascular-outcomes#abstract. Accessed November 2019.
(2019 July 12) Cholesterol Test. Mayo Clinic. Available online at https://www.mayoclinic.org/tests-procedures/cholesterol-test/about/pac-20384601. Accessed November 2019.
Komaroff, Anthony L. (2019 June 19, Updated) Should You Increase HDL, and How? Harvard Medical School. Available online at https://www.health.harvard.edu/heart-health/should-you-increase-hdl-and-how. Accessed November 2019.
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://184.108.40.206/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. 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. Accessed July 2008.
American Heart Association. What Your Cholesterol Level Means. (April 7, 2008). Previously available online at http://220.127.116.11/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. 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. 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. Accessed May 2010.
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. 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. 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. 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. 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. Accessed July 2013.
Devkota, B. (2014 January 16 Updated). HDL Cholesterol. Medscape Drugs & Diseases. Available online at http://emedicine.medscape.com/article/2087757-overview#showall. Accessed on 5/01/16.
Singh, V. (2013 June 19 Updated). Low HDL Cholesterol. Medscape Drugs & Diseases. Available online at http://emedicine.medscape.com/article/127943-overview. Accessed on 5/01/16.
Singh, V. (2014 December 18 Updated). High HDL Cholesterol. Medscape Drugs & Diseases. Available online at http://emedicine.medscape.com/article/121187-overview. Accessed on 5/01/16.
(© 1995– 2016). Cholesterol, HDL, Serum. Mayo Clinic Mayo Medical Laboratories. Available online at http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8429. Accessed on 5/01/16.
(2016 March 28 Updated). About Cholesterol. American Heart Association. Available online at http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.Vy9WX3q9b5M. Accessed on 5/01/16.
Couzin-Frankel, J. (2016 March 10). Why high 'good cholesterol' can be bad news. Science v 352 (6286). Available online at http://www.sciencemag.org/news/2016/03/why-high-good-cholesterol-can-be-bad-news. Accessed on 5/01/16.
Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PW; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2889-934.
Lloyd-Jones DM, Morris PB, Ballantyne CM, Birtcher KK, Daly Jr DD, DePalma SM, Minissian MB, Orringer CE, Smith SC. 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2016. Available as pdf at http://content.onlinejacc.org/article.aspx?articleID=2510936#tab1.