HDL vs. LDL: The “Good” and “Bad” Cholesterol Breakdown

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The body produces two major types of lipoproteins that carry cholesterol to and from the heart:

High-density lipoprotein (HDL): This is considered good cholesterol because it recycles LDL cholesterol, transporting it out of the bloodstream to the liver. This protects us from heart attacks and strokes. High HDL protects us from heart disease, but it's not a cure-all since only one-fourth to one-third of blood cholesterol is carried by HDL.

Low-density lipoprotein (LDL): This is termed bad cholesterol because it contributes to atherosclerotic fatty plaques in our arteries that make us more prone to heart attacks and strokes. The body makes more than enough LDL cholesterol on its own, so excess amounts are usually obtained through our diet.

This article will provide more information on the difference between HDL and LDL.

cholesterol numbers

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HDL and LDL Cholesterol by the Numbers

A lipid panel is a blood test that shows your total cholesterol levels. In addition to tracking HDL and LDL levels, it's important to keep an eye on triglyceride levels. High triglyceride levels also put you at a higher risk of heart disease. 

Although a lipid test can be done with or without fasting, you are more likely to get accurate results by fasting, especially if your triglycerides are going to be measured. This means you can have nothing but water for nine to 12 hours before the test.

Optimal HDL levels are 40 milligrams per deciliter (mg/dL) for adult men and 50 mg/dL for adult women, although HDL levels that are consistently above 60 mg/dL are associated with a precipitous decrease in your heart disease risk.

Optimal LDL levels are below 100 mg/dL for both adult men and adult women.

HDL levels

  • Over 60 mg/dL (optimal levels)
  • 40 to 60 mg/dL (good levels)
  • Below 40 mg/dL (low levels)

LDL levels

  • Under 100 mg/dL (optimal levels)
  • 100 to 129 mg/dL (borderline high levels)
  • 130 to 159 mg/dL (mildly high)
  • 160 to 189 mg/dL (high)
  • 190 mg/dL or above (very high)

The American Heart Association recommends getting at least one cholesterol blood test by age 20, although more frequent testing is suggested for those with a family history of high cholesterol levels and early cardiovascular disease, especially if there is suspicion of familial hypercholesterolemia (FH). Testing is suggested as early as 2 years of age for those with suspicion or diagnosis of FH.

How Often Should You Test Your Cholesterol?

The U.S. Preventive Services Task Force (USPSTF) and the American Heart Association recommend that men ages 45 to 65 and women ages 55 to 65 get tested every one to two years.

The test for non-HDL cholesterol isn't usually part of screening for your total cholesterol, but your healthcare provider may ask you to check these levels if you have high blood pressure, diabetes, or other risk factors for heart disease.

Risk Factors

When it comes to managing your cholesterol, there are modifiable and nonmodifiable risk factors. Some healthy lifestyle measures that you should be aware of to lower your risk of cardiovascular disease include:

  • Lowering blood pressure
  • Managing diabetes by keeping blood sugar levels within appropriate ranges
  • Exercising. The Centers for Disease Control and Prevention (CDC) and USPSTF recommend 150 minutes of moderate-intensity exercise per week. Maintaining a healthy weight has been shown to decrease LDL levels, while increasing physical activity has been shown to increase HDL levels.
  • Eating a heart-healthy diet. This includes 10 grams to 20 grams of soluble fiber, low-sodium meals, and a diet high in fruits and vegetables. Increasing fish oils, niacin, and fiber in your diet has also been shown to reduce non-HDL levels.
  • Limiting red meat intake. High red meat intake has been associated with higher LDL levels, leading many to support plant-based and whole-food diets like the DASH and Mediterranean diets.
  • Quitting smoking. Smoking has been shown to raise LDL and lower HDL levels. Quitting smoking is one of the quickest and most effective ways of changing your cholesterol profile for the better.

There are a number of nonmodifiable risk factors that may impact your cholesterol levels. While these factors are out of your control, they underscore the importance of controlling your modifiable factors so you are not further exacerbating your heart disease risk. 

Nonmodifiable risk factors include:

  • Age and sex: As women and men get older, their cholesterol levels rise. Cholesterol levels tend to begin rising between the ages of 45 and 55 years old in men, while increases in cholesterol are seen at or before the age of menopause for women. Generally, women have lower cholesterol levels than men throughout their lives, but it does not mean that women can be more relaxed when it comes to heart health.
  • Genetics: Your genes partly determine how much cholesterol your body makes. Some people inherit defective cholesterol transporting genes from their parents, a condition called familial hypercholesterolemia that results in abnormally high cholesterol levels.
  • Race: The connection between race and increased risk of high blood cholesterol is controversial, but some studies have shown that African Americans are more likely than Whites to have higher HDL and LDL cholesterol levels.

Complications

Low HDL levels or high LDL levels can lead to high blood cholesterol levels. It’s important to note that high cholesterol does not necessarily mean that you will have a heart attack or stroke, but if your levels are uncontrolled it can lead to these complications.

Uncontrolled blood cholesterol levels can lead to a condition called atherosclerosis, in which plaque builds up along the walls of your blood vessels throughout the body. Over time, blood vessels can narrow and become occluded if these atherosclerotic plaques rupture. Lowering cholesterol levels, often via diet, exercise, and the use of a statin, is vital to mitigating heart or blood vessel diseases, which include the following:

A cardiologist or another healthcare provider can assess your heart disease risk by calculating an atherosclerotic cardiovascular disease (ASCVD) risk score.

The ASCVD risk scale considers your:

  • Cholesterol levels
  • Age
  • Sex
  • Race
  • Blood pressure

This test can determine your risk of having a cardiovascular event in the next 10 years. Therefore, it is not only an informative tool that helps you to avoid serious health complications, but it also helps your doctor determine the level of statin and lifestyle modifications you will need.

Summary

High-density lipoprotein (HDL) is considered good cholesterol and low-density lipoprotein (LDL) is considered bad cholesterol.

A Word From Verywell

The key to living a life free of heart disease is to manage your cholesterol before it becomes a problem via regular cholesterol testing, healthy eating, and routine exercise. Small changes like managing stress and maintaining a healthy weight have been shown to lower LDL levels and raise HDL levels.

As you get older, it becomes more and more important to talk to a healthcare provider about your cholesterol levels, especially if you are feeling symptoms of heart disease. Not only does knowing your cholesterol levels inform you and your doctors about your risk of developing heart and blood vessel disease, but it also makes it easier to create and tailor an individualized plan aimed at managing your cholesterol levels.

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