Cholesterol can be confusing, especially when many of us are used to just hearing about “good” and “bad” cholesterol. For a long time, having elevated HDL cholesterol has been perceived as the best way to protect your heart health and indicate a low risk for things like plaque buildup and heart attacks. 

However, as we’ve learned more about cardiovascular wellness, our understanding of HDL has also evolved—and it turns out that there’s more to the story of blood lipid markers. Let’s take a look at what’s most important to know about your HDL and why non-HDL cholesterol levels matter even more.

What is HDL Cholesterol?

High-density lipoprotein (HDL) is one of the five main types of lipoproteins (proteins that combine with and/or transport fats in your blood) that move cholesterol throughout your body. 

What makes HDL unique is its role in reverse cholesterol transport. It helps carry excess cholesterol away from your arteries (where it can build up and promote blockages) and back to your liver, which processes it for removal. 

This protective mechanism is why HDL has long been called the “good” cholesterol. However, our understanding of cholesterol and cardiovascular risk has evolved, and it’s not as simple as “good” versus  “bad”. 

While having good HDL numbers is still important for heart health, newer research emphasizes that LDL (low-density lipoprotein)—AKA “bad” cholesterol—is an independent and even more potent risk factor for heart disease, especially when you also have elevated Lp(a).

The once-popular LDL-to-HDL ratio is no longer considered a standalone indicator of risk, though many clinicians still use it. Instead, providers should now focus more on the absolute level of LDL and the overall balance of non-HDL cholesterol. HDL is one piece of the puzzle, but it shouldn’t distract from the critical goal of lowering high LDL.

Understanding Non-HDL Cholesterol

Non-HDL cholesterol is calculated by subtracting your HDL number from your total cholesterol. This number gives you all the other lipoproteins that can contribute to plaque buildup in your arteries. These include LDL, VLDL (very-low-density lipoprotein), IDL (intermediate-density lipoprotein), and other atherogenic particles.

Unlike LDL, knowing your non-HDL cholesterol number (and tracking it over time) provides better information. It’s essentially your total burden of cholesterol that can damage blood vessels.

Why HDL Matters for Heart Health

HDL cholesterol has long been valued for its cardioprotective role. It clears cholesterol from your blood, yes, but that’s not all it does.

HDL has anti-inflammatory and antioxidant properties, and it supports endothelial function, helping support healthy blood vessels. All of this is important to reduce plaque buildup, improve circulation, and protect against atherosclerosis.

Still, it’s not just about having high HDL cholesterol levels. The quality and function of HDL matter just as much, if not more. Research has shown that at very high levels, HDL can become dysfunctional and lose its protective properties. This dysfunction may result in HDL particles that are pro-inflammatory and don’t clear cholesterol as effectively. 

Postmenopausal women, who are experiencing changes in hormone levels and lipid metabolism, may be more susceptible to this shift in HDL function. 

Overall, having optimal HDL levels is good, but the focus is shifting from merely raising HDL to supporting its functionality through healthy lifestyle strategies and addressing overall lipid balance.

What Does Having Elevated HDL Cholesterol Mean?

HDL levels are considered within a healthy range when they’re above 40 mg/dL for men and above 50 mg/dL for women. 

It used to be that higher was even better, and that if you had HDL levels above 60 mg/dL, this had an extra protective effect. However, more recent research suggests that very high HDL cholesterol (especially when it climbs above 90–100 mg/dL) may not be as helpful as once believed. Sometimes, having very high HDL may even come with risks. 

Having extremely elevated HDL cholesterol doesn’t necessarily mean your body is clearing cholesterol better than at lower levels. Super high HDL can be dysfunctional, potentially encouraging inflammation or oxidative stress (especially in post-menopausal women, like I mentioned earlier). 

This is why understanding all of your heart health biomarkers is so important. (See my post on cardiac panel results for more information.) Even if you have healthy (or high) HDL, you can still be at risk for heart disease if your LDL, non-HDL cholesterol, or triglycerides are elevated.

A variety of factors can influence your HDL levels:

• Genetics: Just like some people have familial hypercholesterolemia or high lipoprotein A (like me), others are naturally predisposed to having higher (or lower) HDL due to inherited traits.
• Alcohol: Moderate alcohol consumption (no more than 1 drink per day for women and no more than 2 drinks per day for men) has been suggested to be associated with higher HDL. However, that doesn’t mean drinking more is better, and if you don’t drink alcohol now, there’s no reason to start. 
• Exercise: Regular physical activity, especially aerobic exercise (like jogging, brisk walking, rowing, swimming, or playing tennis), can help support healthy HDL levels.

How to Support Healthy HDL and Non-HDL Cholesterol Levels

Knowing your cardiovascular risk numbers is the first step toward improving heart health, but even then, it’s not just about chasing one number in your labwork. 

What’s more effective is evaluating your current lifestyle habits and identifying areas where you could make improvements (we all have them). By optimizing your everyday choices, you can help increase HDL and lower non-HDL cholesterol numbers and better support your cardiovascular wellness overall. 

Here are some places I recommend starting: 

• Science-based nutrition: A diet rich in minimally processed foods, soluble fiber (like oats, beans, and flaxseeds), and healthy fats (like nuts, seeds, avocado, and olive oil) can help lower LDL and non-HDL cholesterol while supporting overall lipid balance. Reducing intake of saturated fats, trans fats, and ultra-processed foods is also key to slowing plaque formation.
• Exercise: Regular aerobic activity can help raise HDL, improve HDL function, and lower non-HDL cholesterol. Even 30 minutes a day, five days a week, can make a big impact.
• Smoking: Tobacco use decreases HDL and damages your blood vessels. Quitting smoking is one of the fastest ways to protect your arteries and improve cholesterol function. If you smoke and need help quitting, reach out to your healthcare provider for resources.
• Alcohol: Moderate alcohol intake might increase HDL to an extent, but there are also downsides to drinking. It’s best to limit or avoid alcohol for cardiovascular and overall wellness. 
• Sleep and stress: Poor sleep and chronic stress can worsen lipid profiles by encouraging ongoing inflammation. Try to prioritize a consistent sleep schedule that allows 7-9 hours per night, and practice stress management before you’re stressed. Things like calming music, journaling, or spending time in nature can help. 

Heart disease is a process, not a switch that flips on overnight. Plaque builds up gradually, often silently, and is influenced by a variety of risk factors, including cholesterol, blood pressure, inflammation, and insulin resistance. 

That’s why I created Optimize, my 6-week group program that goes beyond generic advice to teach both the science of cardiovascular health and the real-life strategies that make lasting change possible. 

From understanding how plaque forms to reversing risk through personalized, evidence-based nutrition, this is about taking control of your health from the inside out. Click here to learn more about Optimize, my 6 week group program or schedule a complimentary 15-minute discovery call with me to discuss my 1 on 1 cardiology nutrition services.

HDL: The Takeaways

Having a high HDL has long been perceived as the poster child of good heart health, but there’s much more to the story. HDL is part of it, but it’s even more important to know your non-HDL cholesterol numbers to get a larger picture of your cardiovascular risk. From there, optimizing your heart health through science-based nutrition, exercise, and other lifestyle practices is key.

Sources

1. Bailey A, Mohiuddin SS. Biochemistry, High Density Lipoprotein. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549802/ 
2. American Heart Association. (2024). HDL (Good), LDL (Bad) Cholesterol and Triglycerides. https://www.heart.org/en/health-topics/cholesterol/hdl-good-ldl-bad-cholesterol-and-triglycerides 
3. Bhatia H, et al. (2024). Independence of Lipoprotein(a) and Low-Density Lipoprotein Cholesterol–Mediated Cardiovascular Risk: A Participant-Level Meta-Analysis. Circulation, 151:4. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069556 
4. Hansen MK, Mortensen MB, Warnakula Olesen KK, Thrane PG, Maeng M. Non-HDL cholesterol and residual risk of cardiovascular events in patients with ischemic heart disease and well-controlled LDL cholesterol: a cohort study. Lancet Reg Health Eur. 2023 Nov 4;36:100774. doi: 10.1016/j.lanepe.2023.100774. PMID: 38019978; PMCID: PMC10652132. https://pubmed.ncbi.nlm.nih.gov/38019978/ 
5. Raja V, Aguiar C, Alsayed N, Chibber YS, ElBadawi H, Ezhov M, Hermans MP, Pandey RC, Ray KK, Tokgözoglu L, Zambon A, Berrou JP, Farnier M. Non-HDL-cholesterol in dyslipidemia: Review of the state-of-the-art literature and outlook. Atherosclerosis. 2023 Oct;383:117312. doi: 10.1016/j.atherosclerosis.2023.117312. Epub 2023 Sep 30. PMID: 37826864. https://pubmed.ncbi.nlm.nih.gov/37826864/ 
6. Rohatgi A, Westerterp M, von Eckardstein A, Remaley A, Rye KA. HDL in the 21st Century: A Multifunctional Roadmap for Future HDL Research. Circulation. 2021 Jun 8;143(23):2293-2309. doi: 10.1161/CIRCULATIONAHA.120.044221. Epub 2021 Jun 7. PMID: 34097448; PMCID: PMC8189312. https://pmc.ncbi.nlm.nih.gov/articles/PMC8189312/ 
7. Franczyk B, Rysz J, Ławiński J, Rysz-Górzyńska M, Gluba-Brzózka A. Is a High HDL-Cholesterol Level Always Beneficial? Biomedicines. 2021 Aug 25;9(9):1083. doi: 10.3390/biomedicines9091083. PMID: 34572269; PMCID: PMC8466913. https://pmc.ncbi.nlm.nih.gov/articles/PMC8466913/ 
8. Centers for Disease Control and Prevention. (2025). About Moderate Alcohol Use. https://www.cdc.gov/alcohol/about-alcohol-use/moderate-alcohol-use.html 
9. Wilkens TL, Sørensen H, Jensen MK, Furtado JD, Dragsted LO, Mukamal KJ. Associations between Alcohol Consumption and HDL Subspecies Defined by ApoC3, ApoE and ApoJ: the Cardiovascular Health Study. Curr Probl Cardiol. 2023 Jan;48(1):101395. doi: 10.1016/j.cpcardiol.2022.101395. Epub 2022 Sep 10. PMID: 36096454; PMCID: PMC9691554. https://pmc.ncbi.nlm.nih.gov/articles/PMC9691554/ 
10. Franczyk B, Gluba-Brzózka A, Ciałkowska-Rysz A, Ławiński J, Rysz J. The Impact of Aerobic Exercise on HDL Quantity and Quality: A Narrative Review. Int J Mol Sci. 2023 Feb 28;24(5):4653. doi: 10.3390/ijms24054653. PMID: 36902082; PMCID: PMC10003711. https://pubmed.ncbi.nlm.nih.gov/36902082/