What Causes Low HDL Cholesterol Levels?

Smoking, Poor Diet, Lack of Exercise and More

Low high-density lipoprotein (HDL) cholesterol levels can increase your heart risk. Having a low level of this "good" cholesterol is a concern, just as having high levels of triglycerides and low-density lipoprotein (​LDL) cholesterol can have negative effects on your heart health.

Lifestyle choices, such as diet and exercise, and genetic factors can contribute to low HDL levels.

This article explains the causes of low HDL, what the optimal levels are, and how HDL plays a role in your overall health. It also covers how you can raise your HDL levels.

causes of low HDL cholesterol
Verywell / Emily Roberts

Causes of Low HDL

A number of conditions and lifestyle choices play a role in lowering HDL levels. They include:

  • Excess weight: If you are overweight or obese, losing weight can increase HDL levels and lower your risk of heart disease.
  • Genetic factors: Sometimes, very low HDL cholesterol levels can be inherited. Medical conditions that severely lower HDL levels include Tangier’s disease and familial hypoalphalipoproteinemia.
  • Poor diet: What you eat can also influence your HDL levels. Limit saturated fats (for example, butter, cream, whole or 2% milk, beef, pork, chicken with skin) and substitute them with monounsaturated fats, found in olives and avocados, and polyunsaturated fat.
  • Sedentary lifestyle: Adding moderate exercise to your daily routine could slightly increase your HDL levels. Try doing aerobic exercises 40 minutes a day, three or four times a week. "Aerobic" includes activities like swimming, brisk walking, running, bicycling, and dancing.
  • Smoking: The chemicals found in cigarettes can lower your HDL cholesterol. Quitting smoking can help increase your HDL, as well as prevent other chronic diseases, including cardiovascular disease.
  • Uncontrolled diabetes: Having high blood glucose (sugar) levels may contribute to lowering HDL cholesterol levels. It can also increase triglyceride and LDL levels. Getting your blood sugar under control may help to raise HDL levels.

Why HDL Matters

HDL removes cholesterol from your arteries and takes it to the liver for removal from the body, which protects you from clogged arteries that lead to a heart attack or stroke.

Studies have shown that low HDL levels are linked to an increased risk of developing cardiovascular disease. This is especially true if other lipids in your blood, such as LDL cholesterol and triglycerides, are also high.

Likewise, research suggests that, to a certain extent, high HDL levels are linked to a lower risk of cardiovascular disease.

It's important to understand that there is no direct, causal relationship found between HDL levels and having a heart attack or stroke, which suggests that other factors may be at play. A person's HDL level is just one piece of the health puzzle.

How Are Cholesterol Levels Checked?

Cholesterol levels are checked with a test called a lipid panel, which requires a blood draw. Lipid profiles test your HDL, LDL, and triglyceride levels. You may have to fast for eight to 12 hours prior to the blood draw to get an accurate test result.

Optimal HDL Levels

Optimal HDL levels vary for women and men. The optimal levels are:

  • More than 40 milligrams per deciliter (mg/dL) for males
  • More than 50 mg/dL for females

However, healthcare providers tend to focus less on the actual HDL number and more on a person's overall heart health. They then consider how the HDL number contributes to their assessment.

For example, a person who is overweight and smokes may have a low HDL on a routine blood test. Instead of prescribing a medication to increase the HDL to a "normal" number, a healthcare provider may focus on smoking cessation counseling, exercise, and weight loss.

These measures can all raise HDL. In fact, they may be as effective as medication in order to increase a person's HDL level.

How Often Should You Have Cholesterol Checked?

Healthy adults should have a lipid profile test every four to six years. Anyone who has diabetes, heart disease, or a family history of high cholesterol should be tested more frequently. Children and younger adults should have a lipid profile baseline established between ages 9 and 11 and again between ages 17 and 21.

Cholesterol Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

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HDL is the "good" cholesterol that helps remove cholesterol from your arteries. Higher levels are considered better for heart health. Normal levels are at least 40md/dL for men and 50 mg/dL for women.

Your HDL level is important, but your healthcare provider will likely focus less on the number and more on what it means. That may mean lifestyle changes, which can put you in control of your weight, diet, smoking habits, and other contributing factors.

Frequently Asked Questions

  • Can stress cause low HDL?

    Yes, some studies show that stress and anxiety affect cholesterol, and lower HDL levels. One study of 5,000 people found there's evidence that job stress, in particular, may affect HDL. You may want to consider stress factors as you make lifestyle changes to improve your HDL numbers.

  • Do eggs increase HDL?

    One study of 37 people, designed specifically to measure how eating eggs would change HDL levels, found that up to three eggs per day led to favorable HDL changes in young, healthy people. Similar results were found for people with plant-based diets who added two eggs to their breakfast menu.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. Acharjee S, Boden WE, Hartigan PM, et al. Low levels of high-density lipoprotein cholesterol and increased risk of cardiovascular events in stable ischemic heart disease patients: A post-hoc analysis from the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation)J Am Coll Cardiol. 2013;62(20):1826-1833. doi:10.1016/j.jacc.2013.07.051

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  7. Centers for Disease Control and Prevention. Getting your cholesterol checked.

  8. American Association for Clinical Chemistry. HDL cholesterol.

  9. Assadi SN. What are the effects of psychological stress and physical work on blood lipid profiles? Medicine (Baltimore). 2017 May;96(18):e6816. doi:10.1097/MD.0000000000006816.

  10. DiMarco DM, Norris GH, Millar CL, Blesso CN, Fernandez ML. Intake of up to 3 Eggs per Day Is Associated with Changes in HDL Function and Increased Plasma Antioxidants in Healthy, Young Adults. J Nutr. 2017 Mar;147(3):323-329. doi:10.3945/jn.116.241877.

  11. Thomas MS, Puglisi M, Malysheva O, Caudill MA, Sholola M, Cooperstone JL, et al. Eggs Improve Plasma Biomarkers in Patients with Metabolic Syndrome Following a Plant-Based Diet-A Randomized Crossover Study. Nutrients. 2022 May 20;14(10):2138. doi:10.3390/nu14102138.

By Jennifer Moll, PharmD
Jennifer Moll, MS, PharmD, is a pharmacist actively involved in educating patients about the importance of heart disease prevention.