HDL Cholesterol 

Updated: Jan 16, 2014
  • Author: Bishnu Prasad Devkota, MD, MHI, FRCS(Edin), FRCS(Glasg), FACP; Chief Editor: Eric B Staros, MD  more...
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Reference Range

High-density lipoprotein (HDL) cholesterol is used in the assessment of coronary or other vascular pathology risk.

The reference range of high-density lipoprotein cholesterol (HDL-C) is 40-50 mg/dL in men and 50-60 mg/dL in women.

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Interpretation

High-density lipoprotein cholesterol (HDL-C) levels are increased in the following conditions:

HDL-C levels are decreased in the following conditions:

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Collection and Panels

Specimen type: Plasma or serum

Container: Green-top (heparin) tube, red-top tube, or gold-top 7-mL serum-separating tube (SST; sometimes called marble-top tubes or yellow-topped tubes, referring to the stoppers, which are either gold or red-gray)

Specimen volume: 0.5 mL

Other instructions: The patient should fast at least 12-14 hours before the blood draw for the lipid panel

Panels: Lipid panel

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Background

Description

High-density lipoprotein cholesterol (HDL-C), which consists mostly of cholesterol, phospholipid, and protein, is produced and secreted by the liver and intestine. [2]

HDL-C transports cholesterol from tissues to the liver. In this reverse cholesterol transport process, it performs a "clean-up" function. This process is called reverse cholesterol transport because cholesterol synthesized in peripheral tissues is eventually returned to the liver for its disposal from the body.

HDL-Cs have many surface proteins. Apo-A1 and apo-A2 proteins on HDL-C are derived by direct secretion from the liver. [3] ApoA-I synthesis is necessary to produce HDL-C. Mutations in the apoA-I gene that cause HDL-C deficiency are associated with accelerated atherogenesis. Overexpression of apoA-I in the mouse model protects against experimentally induced atherogenesis. [4] Additionally, HDL-C may protect against atherogenesis by mechanisms not directly related to reverse cholesterol transport. These functions include putative anti-inflammatory, anticoagulant, antioxidative, platelet anti-aggregatory, and profibrinolytic activities. [5]

High levels of HDL-C are desirable because of their inverse relation with coronary risk. HDL-C is called good cholesterol because it is inversely related with the incidence of atherosclerosis.

Indications/Applications

HDL-C is used in the assessment of coronary or other vascular pathology risk.

Considerations

HDL-C levels are decreased in association with recent illness; starvation and stress; smoking; obesity and lack of exercise; medications such as thiazide diuretics, steroids, and beta-blockers; hypertriglyceridemia; and in elevated immunoglobin levels.

HDL-C levels are increased in association with moderate ethanol consumption, insulin, and estrogen. [1] Additionally, regular aerobic exercise, smoking cessation, decrease in body mass index, and statin therapy (mild) increase HDL-C levels. Statins or HMG-CoA reductase inhibitors modestly increase HDL-C levels. The mild rise in HDL-C levels from these drugs may be related to inhibition of rho-signaling pathways with activation of peroxisome proliferator-activated receptor (PPAR)–alpha. Increases in HDL-C levels may also be attributable to decreasing plasma cholesteryl ester transfer protein (CETP) activity by statins. [6]

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