Cholesterol: is HDL, the “good” cholesterol, really good?

This is general information, not medical advice. Always discuss your blood values with your doctor.

1. 1

   A marker, not a goal

   In population studies, low HDL goes together with more cardiovascular disease. But large randomised trials with niacin and CETP inhibitors raised HDL without fewer heart attacks or strokes. Genetic studies (Mendelian randomisation) also show that genes that raise HDL do not lower heart attack risk.

2. 2

   Values: no target

   The European guideline sets no target for HDL. It uses it to refine your risk estimate. An HDL of around 1.0 mmol/L (about 40 mg/dL) or lower is a signal of higher risk and a reason to look at other risk factors.

3. 3

   Very high is not better either

   In the Canadian CANHEART study, mortality was raised at both low and very high HDL levels (a U-shaped relationship). At very high levels it was mainly deaths from causes other than heart disease or cancer. In women this only became significant above about 90 mg/dL (2.3 mmol/L).

4. 4

   And exercise?

   Regular exercise raises HDL and lowers triglycerides. The heart benefit of exercise therefore does not come from HDL alone, and training remains worthwhile. Artificially pushing HDL up with supplements or drugs did not pay off in trials.

Updated in October 2026