HDL cholesterol test explained
Also known as: DTL-Ch
- Updated
- 2026-09-10
- Every number with its source
What HDL cholesterol is
High-density lipoproteins (HDL) collect excess cholesterol from the tissues and from artery walls and carry it to the liver, from where it is removed — this is called reverse cholesterol transport. That is why a higher HDL is usually linked to a lower risk of atherosclerosis and heart disease, while a low HDL is an independent risk factor. Women's HDL is naturally somewhat higher than men's, which is why the reference values differ too. HDL is raised by regular physical activity and a healthy weight, and lowered by smoking, excess weight, inactivity, uncontrolled diabetes and certain medicines. Even so, newer studies show that a very high HDL gives no additional protection, and raising HDL with medicines did not reduce cardiac events. That is why doctors pay more attention to LDL and non-HDL cholesterol, and treat HDL as a risk marker rather than a treatment target. Non-HDL cholesterol is calculated from total cholesterol and HDL, and it covers all the atherogenic fractions.
Reference values
| Group | Value, mmol/l | Source | |
|---|---|---|---|
| Men — healthy adults NHS: above 1.0 mmol/l | above 1.0 | NHS Reviewed 2026-03-13 | |
| Women — healthy adults NHS: above 1.2 mmol/l | above 1.2 | NHS Reviewed 2026-03-13 | |
| Adults from age 20 — ideal value (US reference) MedlinePlus: 60 mg/dl and above (converted to mmol/l) | 1.55 and above | MedlinePlus Reviewed 2024-10-15 | |
According to the NHS, HDL cholesterol in healthy adult women should be above 1.2 mmol/l — a higher limit than for men, for whom above 1.0 mmol/l is given. The NHS page does not explain why the limit for women is set higher: it gives only the separate numeric limits by sex, with no stated biological rationale. MedlinePlus also separates its limits by sex in the case of a low HDL (for women, an HDL below 50 mg/dl counts as low; for men, below 40 mg/dl). The ideal value, however — 60 mg/dl and above (about 1.55 mmol/l) — is given by MedlinePlus as the same for both sexes. So it is worth comparing your own result separately against each reference — against the sex-specific NHS range, or against the MedlinePlus range — because these two sources are not directly comparable with one another.
When HDL is tested
- As part of a lipid panel — as a preventive assessment of cardiovascular risk
- When risk factors are present: smoking, excess weight, diabetes, raised blood pressure, heart disease in the family
- When assessing metabolic syndrome — a low HDL is one of its criteria
- To monitor the effect of lifestyle changes
How to prepare
- According to the NHS, fasting does not greatly affect total cholesterol and HDL; many laboratories nevertheless ask for 8–12 hours without food because of triglycerides (see preparing for a lipid panel)
- Avoid alcohol the day before the test
- Acute illness temporarily lowers HDL — mention it to your doctor
A high HDL result
A high HDL cholesterol is usually considered favourable — it is linked to a lower risk of heart disease. It is raised by physical activity, a healthy weight and female hormones, and lowered by smoking. MedlinePlus treats 60 mg/dl (about 1.55 mmol/l) and above as the ideal value; the sources cited here do not separately assess values above that limit, so an unusually high result is worth discussing with a doctor together with the whole lipid panel.
- Regular physical activity
- A healthy weight
- Oestrogens — in women before the menopause
What to discuss with a doctor:
- Usually nothing — a high HDL is not a cause for concern
- If HDL considerably exceeds the limits given in the sources — discuss it with a doctor together with the whole lipid panel
A low HDL result
A low HDL cholesterol is an independent risk factor for heart disease. The most common causes are smoking, excess weight, low physical activity, uncontrolled diabetes and high triglycerides, certain medicines, and heredity. A low HDL together with high triglycerides and abdominal obesity is a sign of metabolic syndrome.
- Smoking
- Excess weight, especially abdominal obesity
- Low physical activity
- Uncontrolled diabetes, insulin resistance
- High triglycerides
- Certain medicines
- Heredity
- Acute illness — temporarily
What to discuss with a doctor:
- Triglycerides and glucose — a low HDL often goes together with them
- Overall heart risk and LDL — the main treatment targets
- Smoking, weight, physical activity — the factors that change HDL the most
- When to repeat the test
About Lithuania
At the Medicina practica laboratory in Lithuania, HDL cholesterol costs from €6 and a full lipid panel from €20 (September 2026 pricing). Under the prevention programme, a family doctor orders the lipid panel free of charge.
Full site in Lithuanian: proactiva.app
Frequently asked questions
›What is the normal HDL cholesterol level?
The NHS reference for healthy adults is above 1.0 mmol/l in men and 1.2 mmol/l in women. MedlinePlus treats 60 mg/dl and above as the ideal value, which is about 1.55 mmol/l. The higher HDL is, the better it usually is — but a very high HDL brings no additional benefit.
›HDL 0.9 — is that bad?
0.9 mmol/l is below the NHS reference both for men (1.0) and for women (1.2). A low HDL is a heart risk factor, especially together with high triglycerides or excess weight. What changes it most is stopping smoking, physical activity and weight — discuss it with a doctor together with the whole lipid panel.
›How can HDL cholesterol be raised?
The factors that MedlinePlus and the NHS link with a higher HDL: regular physical activity, a healthy weight, not smoking. Medicines to raise HDL did not reduce cardiac events, so doctors pay more attention to lowering LDL. Discuss the specific steps with your doctor.
›Why is the HDL reference higher for women?
Female hormones (oestrogens) naturally raise HDL, so women's values before the menopause are usually higher — the NHS reference is 1.2 mmol/l for women and 1.0 mmol/l for men. After the menopause, HDL often falls.
›What is non-HDL cholesterol?
Total cholesterol minus HDL — it covers LDL and all the other atherogenic fractions. The NHS reference for healthy adults is below 4 mmol/l. Many guidelines consider it a more accurate risk marker than LDL alone.
›How much does an HDL test cost?
At the Medicina practica laboratory, HDL cholesterol costs from €6 and a full lipid panel from €20 (September 2026 pricing). Under the prevention programme, a family doctor orders the lipid panel free of charge.
Sources
- NHS (UK National Health Service) — Cholesterol levels — 2026-09-06
- MedlinePlus (US National Library of Medicine): Cholesterol Levels — 2026-09-06
- Medicina practica — 2026-09-06
Related markers
This site is not an emergency service. If severe chest or head pain, breathlessness, confusion, difficulty speaking, heavy bleeding or another acute problem has come on suddenly — do not wait for tests, call 112.
This information is not a diagnosis and does not replace a consultation with a doctor. Reference ranges depend on the laboratory, your age and sex — always compare your result with the range printed on your own report.