HDL Cholesterol 

Updated: Aug 06, 2019
  • 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 cholesterol (HDL-C) is used in the assessment of coronary or other vascular pathology risk.

Normal findings for HDL-C are as follows [1] :

  • Male: >45 mg/dL or >0.75 mmol/L (SI units)
  • Female: >55 mg/dL or >0.91 mmol/L (SI units)
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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. [3]

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. [4] 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. [5] 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. [6]

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. [2] 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. [7]

A pooled analysis by the NCD Risk Factor Collaboration of 458 population-based studies covering 23 Asian and Western countries determined that in a number of Western nations, as well as in Japan and South Korea, the mean ratio of total-to-HDL cholesterol has declined since 1980, with the reduction in Swiss men being approximately 0.7 per decade between 1980 and 2015. (In contrast, China saw an increase in the ratio.) Also from about 1980 to 2015, HDL-C levels in Japan and South Korea saw a per-decade rise of between 0.04 mmol/L (South Korean men) and 0.17 mmol/L (Japanese women). [8]

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