Test Quick Guide

An HDL cholesterol test (HDL-C) 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, the buildup of certain types of cholesterol in your arteries can heighten the risk of heart disease, stroke, heart attacks, and other health problems.

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

About the Test

Purpose of the test

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

Measuring HDL-C and total cholesterol together in the same blood sample allows the doctor to easily calculate the ratio of HDL-C 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 HDL-C 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-C 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-C 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-C, 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 typical for HDL-C to be tested at set intervals. The most common situations in which HDL-C is monitored over time include:

  • After a prior abnormal cholesterol test: If you have had a previous cholesterol test with low HDL-C 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, HDL 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-C levels are a consideration in the diagnosis of metabolic syndrome, 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-C test analyzes a sample of blood to see how much cholesterol is present within HDL particles. Cholesterol, a waxy substance important for basic cell function such as the formation of cell membranes and certain hormones, is transported through the body in the blood within lipoproteins made up of fat and protein.

There are multiple kinds of lipoproteins that can carry cholesterol including HDL, 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-C helps protect against hardening and blockages of the arteries.

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

When should I get this test?

Whether an HDL-C 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 if you have 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 if you have 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.

It is best if you talk with your doctor about the most appropriate screening plan for your specific situation. An overview of common recommendations for cholesterol screening is listed in the table below:

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

When used to monitor cholesterol over time, HDL-C 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-C testing may be used to monitor your response to therapy.

Although principally used to detect cardiovascular issues, abnormalities in HDL-C 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 can I get an HDL Cholesterol test?

There are several different ways that HDL-C 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, doctors’ 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-C. There are various options for at-home HDL-C 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-C.

Some at-home tests only measure total cholesterol and do not provide a result for HDL-C. 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-C 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-C 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.

Taking an HDL Cholesterol Test

The blood sample for a lab test of HDL-C 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-C does not require you to avoid eating or drinking, it is important to talk with your doctor about whether you need to fast before an HDL-C 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, it is best to 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, 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 phlebotomist 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 phlebotomist 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 you may have mild pain or bruising in your 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-C 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-C is generally measured and reported in milligrams per deciliter of blood (mg/dL). Your test report will show your HDL-C level as well as the reference range for normal or desirable HDL-C levels.

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

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

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

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

HDL-C 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-C is a risk factor for cardiovascular problems including serious conditions like heart disease and stroke. Also, low HDL-C can be a reflection of an underlying condition like diabetes. The health risks of low HDL-C 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-C levels include specific inherited conditions, certain medications, some infections, and many medical conditions that cause inflammation.

HDL-C is an important measurement, but it is rarely evaluated alone. By considering HDL-C 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-C test with your doctor because they are in the best position to explain what the results mean for your health.

Whether you will need follow-up tests depends on the results of your HDL-C 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-C or other cardiovascular risk factors, you may need follow-up tests. These could include repeated or 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.

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

  • What was my HDL-C 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?

Resources

Sources

See More

Ask a Laboratory Scientist

Ask A Laboratory Scientist

This form enables patients to ask specific questions about lab tests. Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, American Society for Clinical Laboratory Science. Please allow 2-3 business days for an email response from one of the volunteers on the Consumer Information Response Team.

Send Us Your Question