HDL Cholesterol Test
Note: this site is for informational purposes only. To view test results or book a test, use the NHS app in England or contact your GP.
The HDL cholesterol test measures the level of high-density lipoprotein (HDL) cholesterol (“good” cholesterol) in the blood using a blood sample, usually taken from a vein in the arm by venepuncture. It is used to assess cardiovascular health and help determine the risk of conditions such as heart disease and stroke.
Why get tested?
To screen for risk of developing cardiovascular disease (heart disease, stroke and related diseases); to monitor treatment
When to get tested?
Aged 40 and above as part of a routine cardiovascular health check, or if you are already thought to be at risk of cardiovascular disease for another reason (including already having suffered from cardiovascular disease).
Sample required?
Testing for HDL cholesterol requires a blood sample. Most often, the blood sample is collected by venepuncture (using a needle to collect blood from a vein in the arm). Occasionally a fingerprick test can be used, although this is not commonly available in GP practices or hospitals in the UK.
Test preparation needed?
No fasting is needed for an HDL-cholesterol test, or the full lipid profile. On the other hand, there may be circumstances when fasting is still required, so you should follow the instructions given by your health care team.
Common questions
HDL-cholesterol testing is usually used to help find out your risk of developing cardiovascular disease. If you have a high cholesterol, your doctor may wish to know how much is non-HDL cholesterol or HDL-cholesterol.
Your HDL-cholesterol can be used, along with total cholesterol and other factors, in “risk calculators” such as QRISK2, which estimate your future risk of getting cardiovascular disease. The value which is entered into the calculator is actually the “total cholesterol to HDL‑C ratio”, i.e. the balance between total cholesterol and HDL cholesterol. Knowing your future risk can guide decisions on making lifestyle changes or starting medical treatments.
HDL is usually requested with other tests, either with cholesterol or as part of a lipid profile, including non-HDL and triglycerides. This is done during a routine cardiovascular risk assessment, which GPs offer to people aged 40 or over. If your doctor thinks you could be at higher risk of cardiovascular disease for another reason, they may recommend HDL testing at other times. It is fairly standard as part of yearly checks in people who have established cardiovascular disease e.g. previous stroke or heart attack.
Low levels of HDL cholesterol are worse than normal HDL cholesterol. The lower your HDL cholesterol level, the higher risk of developing cardiovascular disease. This is because low HDL infers that the LDL particles are smaller and denser than normal which makes them more atherogenic (likely to cause atherosclerotic plaque/furring of the arteries). Having higher than normal HDL is unlikely to have any protective effects in most people.
Other factors can affect your HDL cholesterol result. For example, physical exercise and moderate alcohol consumption increase your HDL cholesterol, whereas smoking reduces it.
HDL cholesterol should not be measured when a person is suddenly unwell. Cholesterol is temporarily low during sudden illness, immediately following a heart attack, or during stress (like from surgery or an accident). You should wait at least 6 weeks after any illness to have cholesterol measured. In women, HDL cholesterol may change during pregnancy. You should wait at least six weeks after your baby is born to have your HDL-cholesterol measured.
This is uncertain. If the cause is due to problem drinking for example then there are no health benefits. There are families who have high HDL (hyperalphalipoproteinaemia) and some of those families have less cardiovascular disease and some more. This may be due to whether the particles work properly but HDL metabolism is incompletely understood. We are increasingly sure however that when HDL is normal any further increases in concentration bring about no further benefit.