# HDL cholesterol

Source: https://synapse-lifestyle.com/en/reference-guide/biomarkers/hdl-cholesterol

Unit: mg/dL

## What is HDL cholesterol?

HDL cholesterol helps bring surplus cholesterol from your blood vessels back to the liver. That's why it's often called the 'tidying-up' cholesterol. A healthy HDL value is associated with more supple blood vessels. Here, slightly higher is usually more favourable, though the overall picture counts for more than this single number.

## Clinical frame

**HDL cholesterol is a risk marker, not a treatment target.** HDL particles carry excess cholesterol from the vessel wall back to the liver and act as anti-inflammatory and antioxidant agents. A low value goes together with a higher cardiovascular risk and is a criterion of the metabolic syndrome [1] [2].

Yet HDL itself is **not a causally protective factor**: genetic studies show no effect of a higher HDL on coronary disease once triglycerides and ApoB are taken into account, and drugs that raise HDL did not prevent events. The low value mainly reflects the underlying profile: high triglycerides, insulin resistance and many ApoB particles [1] [3].

The relationship is not linear: below 40 mg/dL the risk rises, above 70 mg/dL more HDL gives no extra protection and very high values go together with higher mortality [3]. There are therefore no HDL targets. The gain lies in **lifestyle** and in lowering LDL, non-HDL and ApoB [2].

## What moves this value?

Little movement, smoking and lots of fast sugars can lower it. Heredity also plays a role.

Regular movement, healthy fats (olive oil, nuts, oily fish) and quitting smoking lift this slowly but surely.

## What this connects

- [LDL cholesterol](https://synapse-lifestyle.com/en/reference-guide/biomarkers/ldl-cholesterol)
- [Cholesterol](https://synapse-lifestyle.com/en/reference-guide/biomarkers/total-cholesterol)
- [Triglycerides](https://synapse-lifestyle.com/en/reference-guide/biomarkers/triglycerides)

Developed and reviewed with the Synapse [medical advisory board](https://synapse-lifestyle.com/en/advisory-board).

## References

1. Pownall, H. J., Rosales, C., Gillard, B. K. & Gotto, A. M. High-density lipoproteins, reverse cholesterol transport and atherogenesis. Nat Rev Cardiol 18, 712–723 (2021). https://doi.org/10.1038/s41569-021-00538-z
2. Visseren, F. L. J. et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 42, 3227–3337 (2021). https://doi.org/10.1093/eurheartj/ehab484
3. Razavi, A. C. et al. Does Elevated High-Density Lipoprotein Cholesterol Protect Against Cardiovascular Disease? J Clin Endocrinol Metab 109, 321–332 (2024). https://doi.org/10.1210/clinem/dgad406

- [Read more in the reference guide](https://synapse-lifestyle.com/en/reference-guide/heart#Consequence-CSCholesterol-FHDL)
- [All biomarkers in the guide](https://synapse-lifestyle.com/en/reference-guide#biomarkers)

The colour zones are personal: they depend on age, sex, risk and history, and appear in the patient's own report.

Insights to discuss with the patient, not a diagnostic instrument.