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  • Also Known As:
  • High Density Lipoprotein Test
  • High Density Lipoprotein Cholesterol Test
  • HDL-C Test
  • Good Cholesterol Test
  • Formal Name:
  • HDL Cholesterol
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Test Quick Guide

An HDL cholesterol test measures the amount of cholesterol found inside high-density lipoproteins (HDL) in a sample of your blood.

Cholesterol is a waxy substance that helps the cells in your body function properly. However, buildup of certain types of cholesterol in your arteries can heighten the risk of heart disease, stroke, heart attacks, and other health problems.

HDL cholesterol (HDL-C) is often known as “good cholesterol” because it is associated with better cardiovascular health. In contrast, low-density lipoprotein (LDL) cholesterol is called “bad cholesterol” because it is associated with cardiovascular disease.

HDL cholesterol is almost always measured along with total cholesterol, and these two measurements are core parts of the lipid panel test. A lipid panel is a common test measuring HDL cholesterol, total cholesterol, LDL cholesterol, and fat molecules called triglycerides.

About the Test

Purpose of the test

The purpose of HDL cholesterol testing is to assess your cardiovascular health, including your risk for heart disease. HDL cholesterol is considered to be a good type of cholesterol that is associated with a lower risk of coronary heart disease events.

Measuring HDL cholesterol and total cholesterol together in the same blood sample allows the doctor to easily calculate the ratio of HDL cholesterol to non-HDL cholesterol. This is important for assessing your cardiovascular health and allows the doctor to understand the relative amounts of good and bad cholesterols.

Testing of HDL cholesterol can play a role in screening, monitoring, and diagnosing problems that affect your heart, blood vessels, and blood circulation.

Screening

Screening is looking for health problems before any symptoms have occurred. The goal of cardiovascular screening is to better address problems by finding them at an earlier stage.

Screening is one of the most common ways that HDL cholesterol testing is used. In both children and adults who do not have symptoms of cardiovascular problems, cholesterol levels may be checked periodically.

A low level of HDL cholesterol has been tied to an elevated risk of problems like heart disease and stroke. It is also associated with type 2 diabetes. For this reason, HDL-C testing can be used for the early detection of potentially serious health concerns.

Based on an analysis of blood levels of total cholesterol, HDL cholesterol, and LDL cholesterol, doctors can use special formulas to determine whether a patient’s risk level is borderline, intermediate, or high.

Monitoring

In many cases, it is necessary to track cholesterol levels over time. This is known as monitoring, and it is common for HDL cholesterol to be tested at set intervals. The most common situations in which HDL cholesterol is monitored over time include:

  • After a prior abnormal cholesterol test: If you have had a previous cholesterol test with low HDL cholesterol or high LDL cholesterol, you may have ongoing testing to monitor your lipid levels.
  • After a prior cardiovascular problem: If you have been diagnosed with heart disease or have had a heart attack in the past, cholesterol testing can be part of monitoring your health over time.
  • After starting treatment to reduce cardiovascular risk: Sometimes doctors will recommend lifestyle changes or medications to improve your cholesterol levels, and ongoing testing can assess your response to the prescribed treatment.

Diagnosis

Less often, cholesterol tests are for diagnosis, which is identifying the cause of a health problem after symptoms have started.

Doctors may order cholesterol tests if you have certain cardiovascular symptoms. HDL cholesterol levels are a consideration in the diagnosis of metabolic syndrome. Metabolic syndrome is a set of risk factors for diabetes, stroke, and coronary heart disease. Cholesterol testing can also be involved in identifying some health problems affecting other organs.

What does the test measure?

An HDL cholesterol test analyzes a sample of blood to see how much cholesterol is present within high-density lipoprotein (HDL) particles. Cholesterol is a waxy substance that is important for basic cell function. Cholesterol is transported through the body in the blood within lipoproteins, which are made up of fat and protein.

There are multiple kinds of lipoproteins that can carry cholesterol including high-density lipoproteins, low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL).

Cholesterol in LDL and VLDL particles can build up in the arteries and cause cardiovascular problems. In contrast, HDL particles transport cholesterol to the liver so that it can be eliminated from the body. Through this and other functions, HDL cholesterol helps protect against hardening and blockages of the arteries.

In practice, virtually all HDL cholesterol tests also measure total cholesterol, which is the sum of cholesterol found in all the different kinds of lipoproteins. By subtracting HDL cholesterol from total cholesterol, the doctor can determine the amount of non-HDL cholesterol that is present. In addition, tests like a lipid panel use a mathematical formula to calculate the amount of LDL cholesterol in your blood sample.

When should I get an HDL cholesterol test?

Whether an HDL cholesterol test is appropriate depends on your specific circumstances.

As a screening test, there are no universally agreed-upon recommendations regarding how often to measure cholesterol levels. In general, screening is started earlier for people with risk factors such as high blood pressure, cigarette smoking, diabetes, or a family history of heart disease at an earlier age. Ongoing cholesterol testing may occur more often in people with one or more of these risk factors.

People without an elevated risk for cardiovascular problems usually start screening at a later age and often have longer intervals between cholesterol tests.

Every individual should talk with their doctor about the most appropriate screening plan in their specific situation. An overview of common recommendations for cholesterol screening are listed in the table below:

Demographic Group Risk Factors Screening Frequency
Children No risk factors Once between ages 9-11; again between 17-21
Children One or more Every 1-3 years starting when risk factor is identified
Adolescents and Adults of Any Age One or more At least every 5 years; often more frequently based on specific risk factors
Males Age 20-45
Females Age 20-55
No risk factors Every 4-6 years
Males Age 45-65
Females Age 55-65
No risk factors Every 1-2 years
People Over 65 With or without risk factors Annually

Screening is frequently done with a lipid panel, especially for an initial test. However, some screening may be done with only a total cholesterol and HDL-C measurement.

When used to monitor cholesterol over time, HDL cholesterol testing may be recommended if you have already been diagnosed with coronary heart disease. Tracking cholesterol levels can also be important if you have had cardiovascular problems or abnormal cholesterol levels in the past. If you are receiving treatment for these issues, repeated HDL cholesterol testing may be used to monitor your response to therapy.

Although principally used to detect cardiovascular issues, abnormalities in HDL cholesterol can occur with other health problems affecting the thyroid, pancreas, or liver. As a result, cholesterol testing may be involved in the diagnostic process for a range of medical conditions.

Finding an HDL Cholesterol Test

How to get tested

There are several different ways that HDL cholesterol levels can be tested.

Your doctor may prescribe a laboratory test, which requires taking a blood sample from a vein in your arm in a medical office or hospital.

Some clinics, doctor’s offices, pharmacies, and events like health fairs also offer on-site cholesterol testing. Known as point-of-care testing, this test analyzes a drop of blood that comes from pricking your fingertip with a very small needle.

Can I take the test at home?

At-home tests are available that measure HDL cholesterol. There are various options for at-home HDL cholesterol testing.

An at-home self-test involves a fingerstick blood sample that provides results without having to send your sample to a lab. In these self-tests, a drop of blood is applied to a special test paper. The test paper either changes color based on your cholesterol levels or is inserted into a small device that analyzes your blood.

A self-collection test involves taking a fingerstick blood sample at home and then mailing it to a laboratory that measures the level of HDL cholesterol.

Some at-home tests only measure total cholesterol and do not provide a result for HDL cholesterol. For this reason, it is important to look closely at the test to determine if it includes a measurement of HDL-C.

How much does the test cost?

The price for HDL cholesterol testing is variable. Factors that can influence the cost of cholesterol testing include which measurements are included, where the blood sample is taken, and whether you have health insurance.

There may be separate charges for your blood draw, office visits, and laboratory analysis. In many cases, these costs will be at least partially covered by your health insurance if the HDL cholesterol test is recommended by your doctor. You can check with your health care plan for information about costs including a deductible or copayments.

Some health clinics or pharmacies have set prices for point-of-care cholesterol tests. In addition, point-of-care testing may be available for free or at a low cost at community events like health fairs.

At-home test kits differ dramatically in price. Devices that analyze cholesterol from a drop of blood can cost from under $150 to several hundred dollars. If repeat testing is needed, some tests allow you to purchase additional test strips.

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Taking an HDL Cholesterol Test

The blood sample for a lab test of HDL cholesterol is taken from a vein in your arm, and this routine procedure usually occurs in a doctor’s office, laboratory, or hospital.

For at-home tests and point-of-care tests, the sample is a drop of blood obtained from your fingertip.

Before the test

Although accurately measuring HDL cholesterol does not require avoiding eating or drinking, it is important to talk with your doctor about whether you need to fast before an HDL cholesterol test.

Some tests that measure HDL-C also include testing for LDL cholesterol levels, which can be affected by recent food or drink consumption. When fasting is required, you should not eat or drink anything other than water for up to 12 hours before the blood draw

If you are taking a point-of-care or at-home test, you should review instructions in the test kit for information about fasting and any other necessary pre-test preparations.

During the test

If you are having a laboratory-based cholesterol test, you will have a blood sample taken during a routine procedure called a venipuncture. In this procedure, you will be seated, and a technician will wrap an elastic band around your upper arm to increase blood flow in your veins. They will use an antiseptic wipe on the skin near your vein and then insert a needle to withdraw a vial of blood.

This type of blood draw usually takes only a few minutes to complete. It may produce slight pain or a stinging sensation.

To take a point-of-care and or at-home cholesterol test, a small drop of blood will need to be taken from your fingertip. A tiny needle will be used to prick your finger. This may involve a slight stinging feeling.

After the test

When a blood draw is complete, the technician will put a bandage or cotton swab over the puncture site so that it does not continue bleeding. If you were required to fast, you may want to have a snack on-hand for when the test is finished. You can return to normal activities after the test and usually won’t have any lasting effects, although some people can have mild pain or bruising in their arm.

Fingerstick cholesterol tests do not normally cause any ongoing pain or other problems, and you can resume normal activities once the test has been taken. A small bandage can be applied if you notice that your fingertip continues to bleed.

HDL Cholesterol Test Results

Receiving test results

After the blood draw, results from an HDL cholesterol test are typically ready within a few days. A full test report is usually sent to you either electronically or by mail. Your physician may also contact you to discuss your results.

Point-of-care tests with a fingerstick are generally able to deliver results within minutes. Results for these tests are often displayed visually on the test strip or device.

At-home tests that involve sending a blood sample to a laboratory will take longer as the sample must be mailed to the lab and then analyzed.

Interpreting test results

HDL cholesterol is generally measured and reported in milligrams per deciliter of blood (mg/dL). Your test report will show your HDL cholesterol level as well as the reference range for normal or desirable HDL cholesterol levels.

Several factors are involved in the interpretation of your HDL cholesterol test, including:

  • Your age
  • Your sex
  • Your health history and cardiovascular risk factors
  • Your total cholesterol and other lipid levels

Since HDL cholesterol is known as “good cholesterol,” a higher level is better, and HDL cholesterol above 60 mg/dL is generally considered to be excellent.

For most people, an HDL cholesterol level that is above 60 mg/dL is associated with reduced cardiovascular risk. However, high HDL cholesterol can occur because of some medications, alcohol abuse, or thyroid problems. High HDL cholesterol can also occur in some inherited conditions. In these less common cases, high HDL cholesterol may not be beneficial.

HDL cholesterol levels that are under 40 mg/dL are considered to be low, although some organizations consider levels under 50 mg/dL in females to be low.

Low HDL cholesterol is a risk factor for cardiovascular problems including serious conditions like heart disease and stroke. Low HDL cholesterol can also be a reflection of an underlying condition like diabetes. The health risks of low HDL cholesterol can be increased when it occurs in conjunction with other abnormal cholesterol levels, such as high levels of “bad” LDL cholesterol, or with issues like high blood pressure.

Other things that can cause low HDL cholesterol levels include specific inherited conditions, certain medications, some infections, and many medical conditions that cause inflammation.

HDL cholesterol is an important measurement, but it is rarely evaluated alone. By considering HDL cholesterol along with other factors, including levels of LDL cholesterol and other aspects of your overall health, your doctor can better assess your cardiovascular risk.

As a result, it is essential to discuss the results of an HDL cholesterol test with your doctor because they are in the best position to explain what the results mean for your health.

Are test results accurate?

HDL cholesterol testing is extremely common and frequently used to evaluate cardiovascular risk. Like any test, though, HDL cholesterol tests are not perfectly accurate. Certain factors that can influence accuracy of any single test include:

  • Individual variability: There can be some differences in HDL cholesterol levels based on individual factors like stress or posture during the test. Minor variation can also occur between laboratories.
  • Acute illness: Levels of cholesterol in the blood are affected by inflammation, so infections or other illnesses that produce inflammation may interfere with the accuracy of HDL cholesterol tests.
  • Certain blood disorders: Some conditions that affect blood cells cause an increase in a type of protein, known as an M protein, in the blood. In people with these conditions, HDL cholesterol tests may show a lower level of HDL cholesterol than is actually present in their blood.

Point-of-care and at-home tests that use a fingerstick blood sample are nearly as accurate as laboratory testing, but there may be more variability in accuracy based on the brand and the quality of its test.

Do I need follow-up tests?

Whether you will need follow-up tests depends on the results of your HDL cholesterol test.

If you have no risk factors for cardiovascular problems and have healthy levels of HDL and non-HDL cholesterol, you typically do not need any immediate follow-up testing. However, your doctor may recommend repeated cholesterol screening every few years.

If you have low HDL cholesterol or other cardiovascular risk factors, you may need follow up tests. These could include repeated cholesterol tests, expanded cholesterol tests, and/or cardiac stress tests.

If you have an abnormal result on a point-of-care or at-home test, it is normal to have a follow-up cholesterol test with a blood draw so that your blood can be analyzed by a laboratory.

Questions for your doctor about test results

Talking with your doctor can provide the most detailed information about your HDL cholesterol test results. Some of the following questions may be useful in obtaining detailed explanations from your physician:

  • What was my HDL cholesterol level? Is that level healthy for me?
  • Were any other types of cholesterol measured? If so, what were the results of those measurements?
  • Do I have risk factors for cardiovascular disease?
  • Should I have another cholesterol test? If so, when?
  • Are there any other tests that you recommend to evaluate my cardiovascular health?
  • Do you recommend any lifestyle changes or treatments to reduce my risk of cardiovascular disease?

Related Tests

Because there are multiple types of cholesterol and cholesterol tests, it is not always easy to understand what makes each test different. The following sections clarify how HDL cholesterol tests compare with several related tests.

How is an HDL cholesterol test different from a lipid panel?

A lipid panel always includes a measurement of HDL cholesterol, but HDL cholesterol levels can be tested without doing a full lipid panel.

A standard lipid panel measures total cholesterol, HDL cholesterol, and triglycerides. It then uses those measurements to calculate the amount of LDL cholesterol.

How is an HDL cholesterol test different from a total cholesterol test?

A total cholesterol test measures the sum of all cholesterol found in different kinds of lipoproteins. The total cholesterol number includes HDL cholesterol, LDL cholesterol, and VLDL cholesterol.

Because these kinds of cholesterol have distinct implications for cardiovascular health, tests of total cholesterol often measure HDL cholesterol as well so that more information is provided about the ratio of HDL to non-HDL cholesterol in the blood.

How is an HDL cholesterol test different from a low-density lipoprotein (LDL) cholesterol test?

An HDL cholesterol test and LDL cholesterol test measure different types of cholesterol. The two types of cholesterol are transported in the blood in distinct kinds of particles.

In common descriptions, HDL cholesterol is known as good cholesterol while LDL cholesterol is bad cholesterol. The amount of HDL cholesterol compared to LDL cholesterol can be an important consideration in cardiovascular health.

Measuring HDL cholesterol is more straightforward than measuring LDL cholesterol. For this reason, levels of LDL cholesterol are most often calculated using a formula based on levels of total cholesterol, HDL cholesterol, and triglycerides. In some situations, though, a doctor may prescribe a direct LDL test.

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