Good cholesterol is called HDL cholesterol, short for high-density lipoprotein cholesterol. It earned its “good” nickname because it absorbs excess cholesterol from your blood and carries it back to the liver, which flushes it from the body. Higher HDL levels are linked to a lower risk of heart disease and stroke.
What HDL Actually Does in Your Body
Cholesterol doesn’t dissolve in blood, so it hitches a ride on proteins called lipoproteins. HDL particles are the cleanup crew. They pull excess cholesterol out of your artery walls, where it would otherwise accumulate into a waxy buildup called plaque. Plaque narrows arteries over time and can trigger heart attacks and strokes.
Once HDL collects that cholesterol, it delivers it to the liver through a process scientists call reverse cholesterol transport. The liver either recycles the cholesterol, converts it into bile acids, or sends it out through the digestive tract as waste. This is the only mechanism your body has for removing cholesterol that has already lodged in artery walls, which is why HDL plays such a central role in cardiovascular health.
HDL vs. LDL: Good and Bad Cholesterol
LDL stands for low-density lipoprotein, and it works in the opposite direction. LDL carries cholesterol from the liver out into the bloodstream, where high levels can lead to plaque buildup in blood vessels. LDL makes up most of the cholesterol in your body, and when there’s too much of it, the risk of heart disease and stroke climbs.
The simplest way to remember the difference: HDL removes cholesterol from your arteries, LDL deposits it there. Your doctor looks at both numbers together because what matters is the balance between them. A common way to gauge that balance is the cholesterol ratio, calculated by dividing your total cholesterol by your HDL number. For example, a total cholesterol of 200 mg/dL and an HDL of 50 mg/dL gives you a ratio of 4 to 1. Higher ratios signal higher risk. Many clinicians now also look at non-HDL cholesterol (your total cholesterol minus HDL) as a useful predictor of heart disease risk.
Healthy HDL Levels for Men and Women
HDL is measured through a standard blood test called a lipid panel. The targets are slightly different depending on sex:
- Men age 20 or older: 60 mg/dL or higher is best. Below 40 mg/dL is considered low.
- Women age 20 or older: 60 mg/dL or higher is best. Below 50 mg/dL is considered low.
Low HDL is a risk factor for cardiovascular disease on its own, even if your LDL looks fine. But the relationship isn’t perfectly linear. A large study using data from the UK Biobank found that people with HDL levels above 80 mg/dL actually had a 96% higher risk of dying from any cause and a 71% higher risk of cardiovascular death compared to those in the 40 to 60 mg/dL range. The reasons aren’t fully understood, but the takeaway is that extremely high HDL doesn’t keep offering more protection. The sweet spot appears to be in the 60 to 80 mg/dL range for most people.
How to Raise Your HDL
Unlike LDL, which can be driven down effectively with medication, HDL responds best to lifestyle changes. Exercise is the most reliable lever. Research across 28 randomized trials found that moderate to high-intensity exercise produced an average 4.6% increase in HDL. You don’t need marathon training: as little as 60 minutes of moderate-intensity aerobic exercise per week can make a measurable difference.
Diet matters too, though the focus is on the type of fat you eat rather than avoiding fat altogether. Replacing saturated fats (from full-fat dairy, butter, and fatty processed meats) with unsaturated fats (from olive oil, avocados, and nuts) supports higher HDL. Omega-3 fatty acids from fish like salmon and mackerel can raise HDL while also lowering triglycerides. Fiber-rich foods like oatmeal, beans, and avocados also appear to improve HDL levels and the quality of LDL particles.
On the flip side, smoking suppresses HDL. A meta-analysis of 27 studies found that people who quit smoking saw their HDL rise by about 4 mg/dL on average. Excess body weight is also associated with lower HDL, though the relationship is a bit counterintuitive during active weight loss. HDL tends to dip temporarily while you’re losing weight and then rises once your weight stabilizes, so a lower HDL reading mid-diet isn’t necessarily a sign that something is going wrong.
Limiting refined carbohydrates and added sugar rounds out the dietary picture. High sugar intake drives up triglycerides, which tend to move inversely with HDL. Cutting back on sugary drinks and processed snacks can shift both numbers in the right direction.