Myth or fact

The higher your HDL, the better

Short answerNot the way you think

By GyroscopeUpdated November 15, 202611 sources

Not the way you think. People with low HDL do get more heart disease, so a low number tells you something. But when scientists raised HDL on purpose, with three kinds of drugs in tens of thousands of people, heart attacks didn’t fall. People born with genes that raise HDL weren’t protected either. Watch your LDL and non-HDL instead.

Why people believe it

The nickname did a lot of the work. If LDL is the “bad cholesterol”, HDL must be the good one, and more of a good thing sounds better. Big population studies backed it up, finding fewer heart attacks in people with higher HDL, in study after study. HDL particles also carry cholesterol away from tissues, which made a neat story about HDL cleaning out arteries.

Drug companies set out to raise it, and a lot of people with a high HDL relaxed about the rest of their panel.

What HDL is and does

HDL particles pick up spare cholesterol from tissues and help carry it back toward the liver, which is where the “good cholesterol” story came from. They don’t carry ApoB, so they aren’t among the particles that get stuck in artery walls. The HDL number on your panel is the amount of cholesterol inside those particles. It doesn’t measure how well they do their job.

Like a check-engine light

A low HDL is like a check-engine light on your dashboard. It tells you something deserves a look. Putting tape over the light, or wiring it to stay off, doesn’t fix the engine. Raising HDL with a pill turned out to be the tape.

What the studies found

The 2026 guideline says trials don’t support adding niacin or fibrates to a statin to prevent heart attacks and strokes. One drug in the class did help a little. Anacetrapib cut coronary events 9% in 30,449 people, and it lowered non-HDL by 17 mg/dL while it raised HDL, so the benefit fits the drop in the particles that cause plaque.

What a low HDL does tell you

In US adults tested from 2021 to 2023, 13.8% had an HDL under 40 mg/dL, 21.5% of men and 6.6% of women. A low HDL often shows up with high triglycerides, and doctors still use HDL in risk calculators like PREVENT, since it helps predict risk even though raising it doesn’t change it.

The useful response is to work on the things that come with it. Moving more raised HDL about 2.5 mg/dL across 25 trials, and the guideline’s activity advice also lowers triglycerides. The smallest dose that moved HDL was about 120 minutes a week, and longer sessions did more. Two drinks a day raise HDL about 4 points in studies, and that’s no reason to drink, since alcohol raises triglycerides too (triglycerides and HDL).

And a high HDL?

A high HDL doesn’t protect you from a high LDL, and a very high one isn’t better. In two Copenhagen studies of 116,508 people, the lowest death rates came at an HDL of about 73 mg/dL in men and 93 in women. Men at 116 or more and women at 135 or more had higher death rates, about twice as high for the men, and the authors asked for other studies to check it. Take a 220 total with an HDL of 78. The non-HDL is still 142, over the goal of 130 at borderline risk (the total cholesterol myth). The guideline sets goals for LDL and non-HDL whatever your HDL is.