- Red top tube
- 5-7 mL of venous blood
Additional information:
- 12-14 hours fasting before specimen is drawn
- Stable diet for 2 wks
- No alcohol for 24 hr before the test
- HDL is a lipoprotein formed by the liver and intestines, and is mainly composed of phospholipids
- HDL plays an important role in the metabolism of other lipoproteins and transportation of cholesterol from peripheral tissues to liver
Other general notes about cholesterol:
- Cholesterol is a lipid, obtained from the diet (exogenous cholesterol) or synthesized in the body (endogenous cholesterol), mainly by the liver and intestinal mucosa.
- Cholesterol is a component of the cell membrane, and materials that render the skin waterproof.
- An integral component in bile salts, adrenal corticosteroids, estrogen, androgens, and other hormones.
- Serum cholesterol measures the circulating levels of free cholesterol and cholesterol esters.
- The total cholesterol seems to be much less important than the fractions of LDL ("bad"), HDL ("good"), and VLDL
- Total cholesterol = LDL + HDL + VLDL
Clinical Overview:
- Total cholesterol (TC) = LDL + HDL + Triglycerides/5 [Triglycerides/5 estimates VLDL]
- The total cholesterol seems to be much less important than the fractions of LDL ("bad"), HDL ("good"), and VLDL that make up the total cholesterol
- TC:HDL ratio seems predictive of cardiac risk (Framingham Heart Study)
- Males TC:HDL of 5=average risk, 3.4=half of average risk 9.6=double of average risk
- Females TC:HDL of 4.4=average risk, 3.3=half of average risk 7=double of average risk
- HDL>60 mg/dL offers cardiac protective, HDL<40 mg/dL increases cardiac risk
- LDL goals of <100 mg/dL are "optimal" for higher risk patients and <70 mg/dL may be sought for very high risk patients
Indications for testing HDL cholesterol levels include:
- Evaluate persons with known or suspected disorders associated with altered lipoprotein levels
- Evaluate persons with high cholesterol levels or those at higher than average risk of atherosclerotic vascular disease
- Evaluate the response to cholesterol lowering therapy
Additional information:
- Elevated HDL levels protect against atherosclerosis by removing cholesterol from vessel walls and transporting it to the liver, where it is removed from the body
- Decreased levels of HDL (especially <40 mg/dL) are atherogenic
- An HDL-C level is inversely proportional to coronary heart disease (CHD) risk and is a primary independent risk factor
- HDL levels >60 mg/dL protect against heart disease.
- Related laboratory tests include:
- Apolipoprotein A
- Apolipoprotein B
- Aspartate aminotransferase
- Atrial natriuretic peptide
- Blood gases
- B-type natriuretic peptide
- Calcium (blood and ionized)
- C-reactive protein
- Creatine kinase and isoenzymes
- Glucose
- Glycated hemoglobin
- Homocysteine
- Lactate dehydrogenase and isoenzymes
- Lipoprotein electrophoresis
- Magnesium
- Myoglobin
- Potassium
- Total cholesterol
- Triglycerides
- Troponin
Clinical Alert:
- False low levels of Cholesterol and HDL-C may be seen immediately after an acute myocardial infarction; hence the tests are done preferably after a gap of 6-8 weeks.
- Cholesterol/HDL-C ratio provides more information than does either of the values alone.
Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.
| Conv. Units (mg/dL) | SI Units (mmol/L) | |
|---|---|---|
| Adults | ||
Low ( CAD risk) | <40 | <1.04 |
| Acceptable | 40-60 | 1.04-1.55 |
| Desirable (↓CAD risk) | >60 | >1.55 |
The National Cholesterol Education Program (NCEP) classifies HDL-C levels 
60 mg/dL (1.55 mmol/L) as high or cardioprotective.
Conditions associated with increased HDL values include:
- Cholesterol ester transfer protein deficiency
- Chronic liver disease
- Alcoholism
- Cirrhosis
- Hepatitis
- Familial hyperalphalipoproteinemia (HDL excess)
- Hemoconcentration
- Hypobetalipoproteinemia
- Long-term aerobic or vigorous exercise
- Moderate alcohol intake
- Pregnancy - peak 33% higher in second trimester
- Premenopausal women
Drugs and substances that cause increase in HDL levels include:
*Note that some of these agents have variable affect and may decrease or increase HDL*
- Acarbose
- ACE inhibitors
- Albuterol
- Atorvastatin
- Beclomethasone
- Captopril
- Carbamazepine
- Carvedilol
- Cerivastatin
- Chenodiol
- Cholestyramine
- Cimetidine
- Clofibrate
- Coenzyme Q10
- Colestipol
- Corn oil
- Diltiazem
- Doxazosin
- Efavirenz
- Estrogen therapy
- Estrogen/progestin therapy
- Ezetimibe
- Fenofibrate
- Fluvastatin
- Furosemide
- Gemfibrozil
- Glyburide
- Goserelin
- Hydroxychloroquine
- Indapamide
- Insulin
- Isradipine
- Ketoconazole
- Lovastatin
- Medroxyprogesterone
- Metformin
- Methimazole
- Minoxidil
- Nafarelin
- Niacin
- Nicardipine
- Nicotinic acid
- Nifedipine
- Nisoldipine
- Norplant
- Oral contraceptives
- Perindopril
- Phenobarbital
- Phenytoin
- Pindolol
- Pravastatin
- Prazosin
- Prednisone
- Ramipril
- Rosiglitazone
- Rosuvastatin
- Simvastatin
- Terazosin
- Terbutaline
- Theophylline
- Tocetrapib
- Troglitazone
- Verapamil
The National Cholesterol Education Program (NCEP) classifies HDL-C levels 
40 mg/dL (1.04 mmol/L) is low or atherogenic.
Conditions associated with decreased HDL values include:
- Alpha-beta-lipoproteinemia
- Cholestasis
- Chronic renal failure
- Coronary heart disease
- Familial hypertriglyceridemia
- Familial hypoalphalipoproteinemia
- Apolipoprotein C-III deficiency
- Fish eye disease
- Tangier disease
- Hepatocellular diseases
- Lack of exercise
- Nephrotic syndrome
- Obesity
- Poorly controlled diabetes mellitus
- Smoking
- Starvation and anorexia
- Stress and recent illness
- Uremia
Drugs and substances that decrease HDL levels include:
*Note that some of these agents have variable affect and may decrease or increase HDL*
- Acebutolol
- Androgenic and related steroids
- Ascorbic acid
- Atenolol
- Azathioprine
- Beta-blockers
- Bisoprolol
- Carvedilol
- Chenodiol
- Chlorpropamide
- Clofibrate
- Cyclosporin A
- Danazol
- Estrogen/progestin therapy
- Etretinate
- Gemfibrozil
- Hydrochlorothiazide
- Indapamide
- Indomethacin
- Interferon alfa-2a
- Isotretinoin
- Levothyroxine
- Linseed oil
- Lisinopril
- Medroxyprogesterone
- Methimazole
- Methyldopa
- Metoprolol
- Nadolol
- Nandrolone
- Neomycin
- Norplant
- Oral contraceptives
- Prednisolone
- Probucol
- Propranolol
- Psyllium
- Raloxifene
- Sotalol
- Spironolactone
- Stanozolol
- Tamoxifen
- Thiazides
- Timolol
- Trichlormethiazide
- Ursodiol
- Verapamil
- Brewer HB, Jr et al. Clinical significance of high-density lipoproteins and the development of atherosclerosis: focus on the role of the adenosine triphosphate-binding cassette protein A1 transporter. Am J Cardiol. 2003 Aug 21;92(4B):10K-16K
- Covas MI et al. The effect of polyphenols in olive oil on heart disease risk factors: a randomized trial. Ann Intern Med. 2006 Sep 5;145(5):333-41
- Hersberger M et al. Modulation of high-density lipoprotein cholesterol metabolism and reverse cholesterol transport. Handb Exp Pharmacol. 2005;(170):537-61
- LabTestsOnline®. HDL Cholesterol. [Homepage on the Internet] ©2001-2006. Last reviewed on November 23, 2004. Last accessed on October 19, 2006. Available at URL: http://www.labtestsonline.org/understanding/analytes/hdl/test.html
- Mercanligil SM et al. Effects of hazelnut-enriched diet on plasma cholesterol and lipoprotein profiles in hypercholesterolemic adult men. Eur J Clin Nutr. 2006 Sep 13; [Epub ahead of print]
- Navab M et al. Mechanisms of Disease: proatherogenic HDL--an evolving field. Nat Clin Pract Endocrinol Metab. 2006 Sep;2(9):504-11
- The Third Report of the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Available at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf and update with 2004 changes at http://www.nhlbi.nih.gov/guidelines/cholesterol/upd-info_prof.htm