Heart and vessels
HDL-cholesterol
The 'good' cholesterol that carries cholesterol away to the liver; a higher value fits a lower risk of cardiovascular disease.
Everything about this testWhat it measures
HDL (high-density lipoprotein) is a transport particle that picks up cholesterol from the blood vessel wall and the tissues and brings it to the liver, where it is broken down or excreted via the bile. That is why HDL cholesterol is called the 'good' cholesterol. The GP mainly uses HDL to calculate the non-HDL cholesterol (total cholesterol minus HDL): that is the measure of the harmful cholesterol particles in the SCORE2 risk table.
- Increased risk of cardiovascular disease with a low value, especially in combination with high triglycerides and overweight
- Part of the metabolic syndrome (belly fat, high blood pressure, high triglycerides, disturbed blood sugar)
- Needed to calculate the non-HDL cholesterol for the risk estimate
High
A high HDL cholesterol is generally favorable and fits regular exercise, a healthy weight and not smoking; alcohol use, estrogens (contraception, hormone therapy) and some medicines also raise HDL. A higher HDL is not endlessly better: a high HDL does not make up for a high LDL, smoking or high blood pressure, and according to the guideline, treatment does not aim at raising HDL. Very high values can be hereditary or go with liver disease or heavy alcohol use. A high HDL does not cause symptoms.
Low
A low HDL cholesterol goes with a higher risk of cardiovascular disease. It often occurs together with overweight around the belly, little exercise, smoking, high triglycerides and disturbed blood sugar (the metabolic syndrome). Type 2 diabetes, kidney disease, some medicines (including beta blockers and anabolic steroids) and a temporary illness or inflammation also lower HDL. Very low values are rarely hereditary. A low HDL does not cause symptoms; it is a signal to look at the other risk factors.
If your result is abnormal
The GP assesses HDL within the complete lipid profile and the SCORE2 risk estimate. With a low HDL, attention usually follows for weight, exercise, smoking and blood sugar (glucose) and, if needed, treatment of a raised LDL or non-HDL; an isolated low HDL is not treated with medicines.
Reliability
HDL is a risk marker and not a test that shows a disease. In the SCORE2 table of the Dutch GP guideline (NHG) on cardiovascular risk management, HDL counts through the non-HDL cholesterol; the value is always assessed together with total cholesterol, age, sex, smoking and blood pressure. A low HDL on its own is not a diagnosis. According to the guideline, treatment aims at LDL or non-HDL and at lifestyle, not at raising HDL. The measurement does not need to be fasting.
Limitations
- HDL falls temporarily during and up to a few weeks after an infection, surgery or heart attack; preferably measure in a period without illness.
- Smoking, alcohol use, body weight and exercise affect the value, as do estrogens (contraception, menopause) and medicines such as beta blockers and anabolic steroids.
- During pregnancy and up to a few weeks after giving birth, the values are different.
- Laboratories use different measurement methods; preferably compare results from the same laboratory.
How common is this
A low HDL cholesterol is common, especially in people with overweight and type 2 diabetes; there are no separate Dutch figures. In 2024, just over 1.6 million people in the Netherlands were known to their GP to have a lipid metabolism disorder (about 9 in 100 inhabitants) and just over 1.7 million to have cardiovascular disease, men more often than women.
Who is this useful for
Useful as part of the full lipid profile for estimating the risk of cardiovascular disease, with overweight, diabetes or high blood pressure, and with cardiovascular disease in the family. Measured on its own, HDL has little value: without total cholesterol, the non-HDL cannot be calculated. Anyone who wants to improve the value benefits mainly from lifestyle; a high HDL is not a free pass with a high LDL.
Downsides and risks
- A high HDL is often read as 'protection', while it does not make up for a high LDL, smoking or high blood pressure; this can lead to false reassurance.
Sources
Always discuss an abnormal result with your GP. If a result is strongly abnormal, we try to reach you as soon as possible. Read your result yourself as well and contact your GP if in doubt. A test does not make a diagnosis. Read more about risks and results