Good Cholesterol Levels: What to Know

Medically Reviewed by Zilpah Sheikh, MD on June 20, 2024
Written by Stephanie Watson
7 min read

There are two types of cholesterol, the waxy substance found in your blood. Low-density lipoprotein (LDL) cholesterol is considered "bad" cholesterol because it can build up inside your arteries and lead to heart attacks and strokes. The high-density lipoprotein (HDL) type is often called "good cholesterol" because it helps your body get rid of excess LDL cholesterol. 

When a doctor does a lipid panel test to check your cholesterol levels, they look at both types of cholesterol. Health experts say that men (and those identified as male at birth) should aim for an HDL level of 40 to 60 milligrams (mg) per deciliter (dL) to protect against heart disease and stroke. Women, and those identified as female at birth, should aim for 50 to 60 mg/dL.

You've probably heard a lot about the cholesterol you get from foods. But your body also produces cholesterol. Your liver makes it, and your bloodstream carries it out to other areas of your body. There, it carries out important jobs like making hormones and forming cell membranes.

When there's more LDL cholesterol in your blood than your body needs, good cholesterol sweeps it back into to your liver. It's then broken down and removed from your body in your poop. 

In general, good cholesterol also:

  • Reduces inflammation
  • Protects cells and tissues from damage due to oxidation
  • Is involved in preventing blood clots

You might think that if high levels of good cholesterol are healthy, higher numbers would be even better. But the effects of HDL cholesterol are more complicated than experts once thought. And it's possible to have too much.

Very high HDL cholesterol levels don't give you more protection. Even moderately high levels may not protect you if you have certain health issues or unhealthy lifestyle habits. The good cholesterol can start to act like bad cholesterol and increase your risk of disease in your heart and blood vessels.

According to research into HDL cholesterol:

  • One large study found that people with "good cholesterol" levels above 60 mg/dL were nearly 50% more likely to have a heart attack or die from heart disease than people whose HDL levels were between 41 and 60 mg/dL.
  • During the course of another study, people with very high levels of HDL (more than 80 mg/dL for men or 100 mg/dL for women) were at higher risk of dying from problems with their heart and blood vessels and all other causes. 
  • In people who'd had heart attacks and had high blood levels of proteins that signal inflammation, HDL levels over 60 mg/dL increased the risk for further issues with their heart and blood vessels.
  • Older people with HDL cholesterol levels over 80 mg/dL were found to have a 27% higher risk of dementia. 

Why might good cholesterol turn harmful at very high levels or under certain circumstances? Researchers don't know for sure, but they have some ideas.

In some cases, such as when you have system-wide inflammation or other conditions, like diseases of your heart and blood vessels, HDL cholesterol could actually slow down the process of clearing LDL cholesterol from your arteries. When LDL cholesterol builds up in these blood vessels, it forms clumps called plaques that slow or block blood flow. Eventually, a chunk of plaque can break free and form a clot, which could lead to a heart attack or stroke.

Too much HDL might also increase inflammation and oxidation related to these plaques.

A few things can push your HDL level above 60 mg/dL. You can control some of these things but not all of them.

Your genes

Certain genes make you more likely to have high HDL cholesterol. Inherited high HDL sometimes protects against heart disease, but sometimes it increases the risk.

For example, people with a change in the gene SCARB1 have larger-than-normal HDL cholesterol particles in their blood that increase their heart disease risk.

Some people of Japanese descent inherit genes that make them produce too little of the protein CETP, which helps carry cholesterol around the body. Having low CETP leads to high HDL levels in your blood, but it doesn't seem to increase the risk of heart disease.

Certain inherited conditions, like familial hyperalphalipoproteinemia and cholesteryl ester transfer protein (CETP) deficiency, also cause very high levels of good cholesterol.

If you have high HDL and close relatives like your parents or siblings have had heart disease, a heart attack, or a stroke, your doctor might send you to a genetic counselor or heart doctor for more testing.

Your diet

Foods that are high in unsaturated fats, such as fish, nuts, and green leafy vegetables , raise HDL in a good way. But just as they raise bad cholesterol, diets high in saturated fats can increase good cholesterol too much or make it less protective. Foods high in saturated fat include:

  • Red meat
  • Cream and other full-fat dairy products
  • Butter
  • Cheese
  • Cookies, cakes, and other baked goods
  • Fried foods

Excess alcohol consumption

Drinking alcohol tends to increase HDL, which can be a good thing in moderation.  But having more than about two drinks a day could raise your HDL beyond healthy levels or cause it to work differently in your body. It increases LDL levels as well. That puts you at higher risk of high blood pressure, strokes, and heart attacks. 

Medications

Medicines like these can increase HDL levels:

  • Statin drugs and other medications you take to lower LDL cholesterol and triglycerides
  • Birth control pills
  • Hormone replacement therapy for menopause
  • Drugs to prevent seizures
  • Corticosteroids
  • Insulin
  • High doses of niacin

Menopause

While “the change” doesn’t cause a spike in HDL, it does make this good cholesterol less good. Early in life, women tend to have higher HDL than men, which protects them from heart disease. The female hormone, estrogen, seems to boost HDL levels. Lower estrogen levels after menopause change the way HDL cholesterol works in the body, making it less protective against heart disease.

Thyroid problems

Thyroid hormones help your body make and break down cholesterol. People whose thyroid gland is underactive, a condition called hypothyroidism, have higher levels of both HDL and LDL cholesterol.

Liver disease

Primary biliary cholangitis, which causes inflammation of the bile ducts in your liver, can also lead to very high levels of good cholesterol.

If you don't have any symptoms or other heart disease risks, you may not need any treatment for high HDL cholesterol. Your doctor will try to figure out what's causing it and find out if it needs to be treated. If you have high overall cholesterol,  the standard treatment is to lower LDL cholesterol. 

No medications are approved to reduce HDL cholesterol You may be able to lower yours by drinking less alcohol and eating a low-fat diet. It might also help to change your medication if you take a statin or another drug that raises HDL levels.

Stay on top of your cholesterol levels with regular blood tests. Ask your doctor how often you need cholesterol screening based on your risks.

 

How often you need to have your cholesterol levels checked depends on your age, your overall health, your health history, and whether you have risk factors for heart disease. In general, doctors recommend lipid panels:

  • Yearly for people over 65
  • Every 1-2 years for men (and those identified as male at birth) ages 45-65 and women (and those identified as female at birth) ages 55-65
  • Every 5 years for younger people. 

Testing should start at age 9-11 for most children, and as early as age 2 for those with family histories of heart attack, stroke, or high cholesterol.

 

High-density lipoprotein (HDL) cholesterol is often called “good cholesterol” because it helps your body get rid of extra cholesterol. But if your HDL cholesterol levels are very high or you have certain other health conditions, it can lose its protective effects. Talk to your doctor about whether your HDL and overall cholesterol levels are where they should be.  

What are good HDL and LDL levels?

For males (and those assigned male at birth) ages 20 and up, doctors generally recommend these ranges:

  • Total cholesterol: 125-200 mg/dL
  • LDL cholesterol: Less than 10 mg/dL
  • HDL cholesterol: 40 mg/dL or higher

For women (and those assigned female at birth) ages 20 and older: 

  • Total cholesterol: 125-200 mg/dL
  • LDL cholesterol: Less than 10 mg/dL
  • HDL cholesterol: 50 mg/dL or higher

Why does exercise increase HDL cholesterol?

If you're trying to boost your good cholesterol levels, cardio exercise can help. Try to work out at least 5 days a week for at least 30 minutes at a time.Experts don't know exactly how it works, but it's thought to increase the activity of a substance called lipoprotein lipase in your muscles. Lipoprotein lipase is involved in breaking down fats in your body. 

What is an alarmingly high good cholesterol level?
HDL cholesterol levels of 80 or more mg/dL are considered high no matter what your gender. But how much HDL cholesterol you have may not matter as much as the way it acts in your body.