There are two types of cholesterol: high-density lipoprotein (HDL), or “good” cholesterol, and low-density lipoprotein (LDL), or “bad” cholesterol. What specialists consider healthy levels of cholesterol may vary from person to person.
HDL is “good,” because it carries about one-fourth to one-third of circulating cholesterol to the liver for excretion.
LDL is “bad,” because in excess, it tends to build up on the inner walls of blood vessels, which causes the vessels to narrow.
This article discusses healthy ranges of HDL and how to raise HDL levels that are too low.
Current guidelines recommend the following:
|HDL cholesterol levels in milligrams per deciliter (mg/dl)|
|Average adult||equal to or above 60 mg/dl|
|Males||above 40 mg/dl|
|Females||above 50 mg/dl|
The protective effect of HDL tends to stop at levels higher than around 1.4 millimole per liter, which is equal to around 54 mg/dl. However, this does not necessarily mean this level is unhealthy.
Having very high HDL levels seems to increase the rate at which fat deposits build up and block arteries. High levels of HDL can also act the way high LDL levels do, increasing the risk of health issues, especially before and after menopause.
Naturally high HDL
Some people may have naturally high levels of HDL due to:
- cholesterol ester transfer protein (CETP) deficiencies or specific genetic mutations to the CETP
- mutations in endothelial lipase molecules, which are molecules that help regulate or raise HDL levels
- primary familial or secondary hyperalphalipoproteinemia
- inflammatory conditions
Another possible reason for having naturally high HDL levels is SR-BI mutations, which cause a rare variant of the major receptor for HDL. This mutation has caused elevated HDL levels in mice, according to a 2016 research paper.
HDL and medications
Certain types of medication may also raise HDL levels, such as:
- oral birth control pills
- estrogen replacement medications
However, according to the Office on Women’s Health, the use of oral birth control pills could make a person more likely to experience a heart attack or stroke. This is because they raise the risk of blood clots, high blood pressure, and hypertension.
Some drugs that doctors use to lower LDL levels can cause sudden drops in the levels of HDL, especially in combination, although that is rare.
A wide range of factors can influence HDL levels.
A person may help improve their “good” cholesterol levels by:
- being less sedentary
- getting at least 2.5 hours of moderate exercise weekly, where possible
- reaching or maintaining a moderate weight
- quitting smoking, if applicable
- treating or managing type 2 diabetes, if applicable
In a 2015 study, people with type 2 diabetes and obesity who followed a low carb, high unsaturated fat, low saturated fat diet experienced a greater increase in HDL levels after 52 weeks than people following a high carb, low unsaturated fat, high saturated fat diet.
Both groups also exercised for 60 minutes per day 3 days per week.
Specific examples of foods that can be especially effective at controlling cholesterol levels include:
- dark leafy greens
- low fat dairy products
- lean meats and fish
- olive oil, sunflower oil, and canola oil
- nut and seed oils
- beans, peas, and lentils
- brown or wild rice
- whole-grain foods
- sweet potatoes, carrots, turnip, and parsnip
- eggplant and okra
- broccoli and cauliflower
- apples, bananas, and citrus fruits
- prunes, berries, and grapes
- melon, mango, and pineapple
- leeks and onions
- tomatoes, especially tomato juices or sauces
- a 150-milliliter glass of unsweetened fruit juice with pulp per day
- almonds, cashews, walnuts, peanuts, pecans, and hazelnuts
- oats and barley
- soy milk, tofu, edamame, and soy yogurt
- juices and yogurts with added plant sterols and stanols
Sterols and stanols are plant chemicals that mimic human cholesterol and block some of its absorption.
Medical conditions and HDL
Treating or managing health conditions that can cause high cholesterol levels may also help improve HDL levels.
Medical conditions that can impact cholesterol levels include:
- type 2 diabetes
- HIV infection
- sleep apnea
- polycystic ovary syndrome
- chronic kidney disease
- multiple myeloma
Things to avoid
People with high LDL levels, high total cholesterol (TC), or high triglycerides — a type of fat circulating in the bloodstream — tend to have low HDL levels. Reducing these cholesterol levels may improve or increase the levels of HDL.
Things to avoid to help decrease high levels of LDL, TC, or triglycerides include:
- foods high in saturated or trans fats, such as animal products, fried foods, and tropical oils
- sugary drinks, such as soda, sports or energy drinks, fruit juices, and sweetened coffees and teas
- alcohol, which people should only drink in moderation
- stress, which people may try to manage through activities such as yoga, meditation, journaling, or talking with friends and family
- lack of sleep, as most adults should aim to get 7–9 hours of sleep per night
Medications to reduce LDL
Many medications can help decrease high cholesterol or LDL levels, such as:
Doctors can prescribe lomitapide to treat familial hypercholesterolemia, a genetic condition that can cause high cholesterol. This drug may cause liver damage, so people taking it may require frequent liver testing.
Bile acid sequestrant medication
Doctors may prescribe bile acid sequestrants to reduce cholesterol levels when statins are not a suitable treatment or are not effective enough.
Bile acid sequestrants can raise triglyceride levels, reduce the efficacy of some medications, and cause diarrhea.
Doctors may inject PCSK9 inhibitors under the skin every 2–4 weeks. Some recommend taking this alongside a statin if a person is at high risk of health complications or if they have a genetic condition that causes high cholesterol.
Doctors may prescribe ezetimibe when a person has a genetic condition causing high cholesterol. Similarly, doctors can prescribe it when statins cause too many side effects or are not effective enough on their own.
Doctors may prescribe mipomersen to treat people with genetic conditions that lead to high cholesterol. This medication may cause liver damage, so people taking it require frequent liver testing.
Doctors measure cholesterol levels using a blood test called a lipid panel, which tests how much of HDL, LDL, and TC is circulating in the bloodstream. It may also test for levels of triglycerides.
It may be necessary to refrain from eating or drinking anything except plain water 9–12 hours before the test.
How often a person needs to contact a healthcare professional to check their cholesterol levels will depend on:
- their age
- risk factors
- their family history of high cholesterol or cardiovascular conditions
Cardiovascular conditions that may affect the frequency of cholesterol tests include stroke, heart attack, and heart failure.
However, general recommendations on cholesterol screening are as follows:
- screening starting at age 19 or younger
- screening roughly every 5 years if no symptoms occur for men aged 20–45 and women aged 20–55
- screening every 1–2 years for men aged 45–65 and women aged 55–65
- annual screening for men aged 65 and older and women aged 55 and older
Most adults should aim to have HDL cholesterol levels of 60 mg/dl or more.
However, healthy HDL levels will vary from person to person depending on factors such as age, underlying health conditions, and genetic disorders.
Maintaining a moderate weight, quitting smoking, and getting enough exercise may help improve a person’s HDL levels.
Factors that reduce high LDL, triglyceride, or TC levels may also help improve the levels of HDL. These factors include following certain dietary and behavioral habits and taking prescription medications.
Regardless of the treatment or cause, it typically takes a few weeks or months to see cholesterol level changes.