Biomarkers · Lipids & Apolipoproteins

HDL Cholesterol

Both low and high values go with higher risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 5% lower risk of death. Risk rises at both ends: not comparable

HDL Cholesterol and risk of death

NHANES, our fit with 95% CIPublished curve

Published curve higher than the NHANES fitNHANES fit higher

Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.

Risk of death per SD (NHANES)0.95×95% CI 0.93–0.97 · 48,488 adults, 7,040 deaths

Published risk of death1.23×HDL-C <30 mg/dL vs lowest-risk group (HDL-C >90 mg/dL: HR 1.10, 1.05-1.15) (95% CI 1.17–1.29) · ChinaHEART project, 3,397,547 Chinese adults aged 35-75 years

Value of the measurement+0.006gain in concordance within age bands; rank 49 of 56 · all tests

HDL Cholesterol across cohorts

0.911.1HR per SD (95% CI)

NHANES · United States, 20–8448,488 people · 7,040 deaths0.95 0.93–0.97

CHARLS · China, 50+7,767 people · 1,209 deaths1.06 0.97–1.15

Risk-of-death ratio per standard deviation, adjusted for age and sex, within each cohort. Cohorts differ in age range, assay, measurement protocol and follow-up, and one SD is a different amount in each, so the comparison is of direction and rough size per SD, not per unit. Vertical line: no association.

HDL Cholesterol by age and sex

Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.

The percentiles as a table

Each row is one sex and age band: the values below which 5%, 25%, 50%, 75% and 95% of people fall (mg/dL), from the survey named in the row. Not a reference range or a target.
Sex	Age	5th	25th	Median	75th	95th	n	Cycle / source
All	20-39	34.0	41.8	50.0	60.0	77.0	1,435	NHANES 2017-2018
All	40-59	34.0	42.0	51.0	62.0	83.0	1,555	NHANES 2017-2018
All	60+	34.0	43.0	53.0	64.0	82.0	1,900	NHANES 2017-2018
All	all	34.0	42.0	51.0	62.0	81.0	4,890	NHANES 2017-2018
Men	20-39	31.1	41.0	47.0	54.6	72.0	685	NHANES 2017-2018
Men	40-59	31.2	39.0	46.0	54.0	71.4	727	NHANES 2017-2018
Men	60+	30.0	39.0	45.0	54.0	72.0	965	NHANES 2017-2018
Men	all	31.0	40.0	46.0	54.0	72.0	2,377	NHANES 2017-2018
Women	20-39	35.0	46.0	55.0	64.0	82.0	750	NHANES 2017-2018
Women	40-59	39.0	48.0	56.0	68.0	88.0	828	NHANES 2017-2018
Women	60+	38.0	49.0	59.0	69.0	89.0	935	NHANES 2017-2018
Women	all	37.0	48.0	56.0	67.0	87.0	2,513	NHANES 2017-2018

What studies found when this marker was changed

They describe what happened in those study groups, not a recommendation. See all catalogued interventions.

Measured changes in HDL Cholesterol, study by study

7 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Study results in the groups studied, not predictions for a person.

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Intervention	Reported effect	Evidence	Source
behavioral	Smoking cessation	HDL-C rose by 0.100 mmol/L (CI 0.074 to 0.127) after smoking cessation; TC, LDL-C, TG unchanged (27 studies)	meta-analysis	Maeda K, et al. The effects of cessation from cigarette smoking on the lipid…
diet	Olive oil 25 mL/day, especially high-polyphenol virgin olive oil	HDL-C +0.045 mmol/L with high-polyphenol olive oil (+0.025 mmol/L with low-polyphenol) over 3 weeks	RCT	Covas MI, et al. The effect of polyphenols in olive oil on heart disease risk…
diet	Low-carbohydrate dietary pattern for 6 months in adults with overweight or obesity	HDL-C increased by 2.31 mg/dL vs usual diet at six months (low certainty)	meta-analysis	Ge L, Sadeghirad B, Ball GDC, et al. BMJ. 2020.
diet	Alternate-day fasting (25% energy on fast days, 125% on feast days) for 6 months in obese adults	HDL-C +6.2 mg/dL (95% CI 0.1 to 12.4) vs daily calorie restriction at 6 months	RCT	Trepanowski JF, Kroeger CM, Barnosky A, et al. JAMA Intern Med. 2017.
diet	Low-carbohydrate diet (<40 g carbohydrate/day) with counselling for 12 months	HDL-C +7.0 mg/dL (0.18 mmol/L; 95% CI 3.0 to 11.0) vs low-fat diet at 12 months	RCT	Bazzano LA, Hu T, Reynolds K, et al. Ann Intern Med. 2014.
exercise	Aerobic endurance training	Aerobic exercise training raised HDL-C by a net 2.53 mg/dL; each 10-minute longer session about 1.4 mg/dL more	meta-analysis	Kodama S, et al. Arch Intern Med. 2007;167:999-1008.
exercise	Structured aerobic, resistance or combined exercise training programmes vs sedentary control	HDL-C increased by 2.11 mg/dL (95% CI 1.43 to 2.79) vs sedentary control	meta-analysis	Smart NA, Downes D, van der Touw T, et al. Sports Med. 2025.

Things that worsen it

Each row is one study: what was changed, the effect it reported on this marker, and the source.
Type	Condition or exposure	Reported effect	Evidence	Source
lifestyle	Visceral adiposity	Baseline CT visceral fat independently predicted lower HDL cholesterol 5 years later (standardized beta = -0.126)	prospective cohort	Hwang YC, et al. Increased Visceral Adipose Tissue Is an Independent Predictor…
pharmacologic	Anabolic-androgenic steroid abuse	Depresses serum HDL-, HDL2- and HDL3-cholesterol (effect size not reported)	review	Hartgens F, et al. Effects of androgenic-anabolic steroids in athletes. Sports…

What else moves this marker

They describe those study groups, not an individual, and an association is not a cause.

Genetic predisposition

Each row is one study: what it compared and the change it reported in this marker.
What	Effect on the marker	Comparison · population	Source
↑ CETP TaqIB (rs708272) B2 allele carriers vs B1B1 · HDL-C in Caucasian B2 carriers vs B1B1 homozygotes	+9.67 mg/dL (95% CI 7.73 to 11.99)	B2 carriers vs B1B1; 0.25 mmol/L (95% CI 0.20-0.31) converted x38.67 · 5,929 Caucasians (genotype-HDL association); CAD meta-analysis of 47 studies	meta analysis · PMID 25366166

Environmental and occupational exposures

Each row is one study: what it compared and the change it reported in this marker.
What	Effect on the marker	Comparison · population	Source
↑ Gestational organophosphate pesticide exposure (urinary diethyl phosphate metabolites), per IQR · Child HDL-C z-score at age 10 per IQR increase in averaged gestational urinary sum-DEAP	+0.14 SD (z-score) Child HDL-C z-score at age 10 per IQR increase in averaged gestational urinary sum-DEAP (95% CI 0.02 to 0.25)	Per 1 IQR increase in gestational sum-DEAP concentration · Generation R Study (Rotterdam), 643 children followed to age 10	prospective cohort · PMID 39447473

Sources

Risk curve: Lu 2024 (PMID 38357392): all-cause HR 1.23 (1.17-1.29) HDL-C <30 mg/dL vs lowest-risk group (HDL-C >90 mg/dL: HR 1.10, 1.05-1.15). Scaled to US values (NHANES).
Lu et al. Association of high-density lipoprotein cholesterol with all-cause and cause-specific mortality in a Chinese population of 3.3 million adults: a prospective cohort study. The Lancet regional health. Western Pacific. 2024;42:100874.
NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.

Map HDL Cholesterol against another biomarker · Featured: HDL × total cholesterol.

Map HDL Cholesterol against another marker