HDL Cholesterol

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No Fasting Required

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Lipid profile to assess cardiovascular risk by measuring cholesterol, LDL, HDL, triglycerides.

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HDL Cholesterol Test Information Guide

Why is it done?
- Measures high-density lipoprotein (HDL) cholesterol, often called 'good cholesterol,' which helps remove other forms of cholesterol from arteries and tissues
- Assesses cardiovascular risk and protective factors against heart disease and stroke
- Screens for dyslipidemia and metabolic disorders affecting lipid metabolism
- Monitors effectiveness of treatment with statins and other lipid-lowering medications
- Evaluates patients with family history of heart disease, high cholesterol, or previous cardiac events
- Part of routine cardiovascular health screening, typically performed every 4-6 years in adults aged 20 and older
- Monitors lipid profiles in patients with diabetes, obesity, hypertension, or metabolic syndrome
Normal Range
- HDL Cholesterol Levels (mg/dL): 60 mg/dL or higher = Desirable (optimal protective level) 40-59 mg/dL = Borderline low (moderate cardiovascular risk) Less than 40 mg/dL (men) or less than 50 mg/dL (women) = Low (increased cardiovascular risk)
- Alternative measurement (mmol/L): 1.55 mmol/L or higher = Desirable 1.03-1.55 mmol/L = Borderline low Less than 1.03 mmol/L (men) or less than 1.29 mmol/L (women) = Low
- Higher HDL levels are protective against cardiovascular disease; each 1 mg/dL increase in HDL reduces cardiovascular risk by approximately 2-3%
- Sex-specific differences exist due to hormonal influences, with premenopausal women typically having higher HDL levels than men of similar age
- Normal ranges may vary slightly between laboratories; always refer to the reference range provided by your specific testing laboratory
Interpretation
- High HDL (60 mg/dL or higher): Considered protective against heart disease and stroke; represents excellent cardiovascular health; associated with lower risk of atherosclerosis and plaque formation
- Borderline low HDL (40-59 mg/dL): Indicates moderate cardiovascular risk; may warrant lifestyle modifications and monitoring; particularly concerning if combined with elevated LDL or triglycerides
- Low HDL (less than 40 mg/dL in men, less than 50 mg/dL in women): Associated with significantly increased cardiovascular risk; major risk factor for coronary heart disease; requires aggressive treatment and lifestyle intervention
- Factors affecting HDL levels: Physical inactivity decreases HDL; regular exercise (150+ minutes weekly) can raise HDL by 5-10% Smoking lowers HDL cholesterol; quitting can increase HDL within weeks Alcohol consumption in moderation may increase HDL; excessive use decreases it Overweight and obesity lower HDL levels High-carbohydrate diets, particularly refined carbohydrates, reduce HDL Trans fats and saturated fats lower HDL levels Hormonal factors including estrogen (higher in women) and thyroid disease affect HDL Medications (beta-blockers, corticosteroids) can lower HDL Age-related changes; HDL tends to decline with age, particularly in men Chronic conditions (diabetes, metabolic syndrome, chronic kidney disease) lower HDL
- Clinical significance: HDL is considered an independent risk factor for cardiovascular disease; low HDL is significant even with normal total and LDL cholesterol; assessment should include HDL/total cholesterol ratio and complete lipid panel interpretation
Associated Organs
- Primary organ systems: Cardiovascular system (heart and blood vessels) - primary target organ Liver - produces and regulates HDL cholesterol Kidneys - affected by cardiovascular complications Endocrine system - hormonal regulation of lipid metabolism
- Associated conditions with low HDL: Coronary artery disease and atherosclerosis Acute myocardial infarction (heart attack) Ischemic stroke and cerebrovascular disease Peripheral arterial disease Type 2 diabetes mellitus and prediabetes Metabolic syndrome Obesity and overweight conditions Hypertension (high blood pressure) Chronic kidney disease and end-stage renal disease Liver disease and hepatic dysfunction Hypothyroidism Systemic inflammatory conditions (rheumatoid arthritis, lupus) HIV/AIDS (often associated with lipid abnormalities)
- Potential complications of low HDL: Accelerated atherosclerosis and plaque accumulation Increased risk of acute coronary syndromes Sudden cardiac death Heart failure development Arrhythmias and conduction abnormalities Recurrent myocardial infarction Stroke and transient ischemic attacks Amputation risk from peripheral vascular disease Kidney disease progression Carotid artery stenosis
Follow-up Tests
- If HDL is low, recommended follow-up tests include: Complete lipid panel (total cholesterol, LDL cholesterol, triglycerides) LDL particle size and density analysis Non-HDL cholesterol calculation Triglyceride levels assessment Lipoprotein(a) [Lp(a)] testing for genetic risk factors Apolipoprotein B (apoB) measurement Blood glucose and hemoglobin A1C for diabetes screening Thyroid function tests (TSH, free T4) Liver function tests (ALT, AST, bilirubin) Kidney function tests (creatinine, eGFR, urinalysis) High-sensitivity C-reactive protein (hs-CRP) for inflammation assessment Lipoprotein-associated phospholipase A2 (Lp-PLA2) for additional risk stratification
- Imaging and diagnostic studies: Electrocardiogram (ECG) to assess cardiac status Carotid ultrasound for atherosclerotic plaque detection Coronary artery calcium (CAC) scoring with CT scan Stress testing or myocardial perfusion imaging if indicated Echocardiography to evaluate heart function Ankle-brachial index (ABI) for peripheral arterial disease screening
- Monitoring frequency: Healthy adults: Recheck every 4-6 years High-risk patients on treatment: Every 4-12 weeks during therapy optimization, then annually Patients with established cardiovascular disease: Every 3-6 months while on treatment After lifestyle interventions: Retest at 3 months to assess response After medication adjustments: Retest 4-12 weeks following dose changes
- Complementary tests: HDL is best interpreted as part of a complete cardiovascular risk assessment including all lipid panel components, Framingham Risk Score, ASCVD risk calculator, and metabolic parameters
Fasting Required?
- Fasting Status: No - fasting is NOT required for HDL cholesterol testing. HDL cholesterol levels remain relatively stable whether fasting or non-fasting.
- However, for complete lipid panel: If HDL is part of a comprehensive lipid panel including LDL and triglycerides, fasting 9-12 hours may be recommended for optimal triglyceride measurement accuracy
- Patient preparation instructions: Schedule test in morning if fasting lipid panel ordered If fasting required: No food or beverages (except water) for 9-12 hours before blood draw Maintain normal diet and activity for 2-3 days before test for accurate results Avoid alcohol consumption for 24 hours before testing Continue taking regular medications unless physician instructs otherwise Avoid strenuous exercise for 24 hours before test Sit quietly for at least 5 minutes before blood draw Wear loose-fitting clothing to facilitate blood draw
- Medications to continue: Take all regular medications including statins, antihypertensives, and other prescribed medications as usual unless specifically directed by your healthcare provider to hold them before testing
- Special considerations: Verify with your laboratory whether fasting is required for your specific test order Recent illness, extreme stress, or recent myocardial infarction may temporarily affect HDL levels Inform healthcare provider of all medications, supplements, and herbal products Inform phlebotomist of any bleeding disorders or medications affecting coagulation

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