HDL, the "Good" Cholesterol

Cholesterol is a waxy, fat-like substance found in every cell of the body. The liver makes it, and it is also in some foods, such as meat and dairy products. The body needs some cholesterol to work properly, but too much in the blood raises the risk of coronary artery disease.

HDL and LDL

Cholesterol travels through the blood attached to proteins, in combinations of fat (lipid) and protein called lipoproteins. The two main types do different jobs:

• HDL (high-density lipoprotein) is sometimes called "good" cholesterol because it carries cholesterol from other parts of the body back to the liver, which removes it.
• LDL (low-density lipoprotein) is sometimes called "bad" cholesterol because high levels lead to cholesterol building up in the arteries.

Testing

A blood test measures cholesterol levels, including HDL. How often depends on age, risk factors and family history. General recommendations:

• Age 19 and under: a first test between ages 9 and 11, then every 5 years. Some children may start at age 2 if there is a family history of high cholesterol, heart attack or stroke.
• Age 20 and over: every 5 years for younger adults; every 1 to 2 years for men aged 45 to 65 and women aged 55 to 65.

Healthy HDL levels

With HDL, higher is better, because a high level can lower the risk of coronary artery disease and stroke.

Raising a low HDL

Lifestyle changes may help — and may also help prevent other diseases:

• Eat healthier fats. Limit saturated fats (full-fat milk and cheese, high-fat meats such as sausage and bacon, and foods made with butter, lard or shortening) and avoid trans fats (in some margarines, fried foods and processed baked goods). Choose unsaturated fats from avocados, vegetable oils such as olive oil, and nuts. Limit carbohydrates, especially sugar, and eat more naturally high-fiber foods such as oatmeal and beans.
• Stay at a healthy weight. Losing weight can raise HDL, especially if you carry a lot of fat around your waist.
• Exercise. Regular exercise can raise HDL and lower LDL; aim for 30 minutes of moderate to vigorous aerobic exercise on most, if not all, days.
• Avoid cigarettes. Smoking and secondhand smoke can lower HDL; ask your provider for help quitting.
• Limit alcohol. Moderate drinking may lower HDL, though more studies are needed; too much alcohol causes weight gain, which lowers HDL.

Some cholesterol medicines, including certain statins, raise HDL as well as lower LDL. Providers don't usually prescribe medicine just to raise HDL, but someone with low HDL and high LDL may need it.

What else can lower HDL

• Certain medicines in some people: beta blockers (a type of blood pressure medicine), anabolic steroids including testosterone, progestins (female hormones in some birth control pills and menopause hormone therapy) and benzodiazepines (sedatives often used for anxiety and insomnia). If you take one of these and your HDL is very low, ask your provider whether to continue.
• Diabetes — another reason to keep it well managed.

Sources

• MedlinePlus, National Library of Medicine: "HDL: The 'Good' Cholesterol."