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HDL CholesterolvsLDL Cholesterol

HDL vs LDL Cholesterol

Understanding the difference between "good" HDL cholesterol and "bad" LDL cholesterol, and why both matter for cardiovascular health.

Aspect
HDL Cholesterol
LDL Cholesterol
What it measures
High-density lipoprotein cholesterol - the "good" cholesterol that removes excess cholesterol from arteries
Low-density lipoprotein cholesterol - the "bad" cholesterol that can build up in artery walls
Optimal direction
Higher is better (>40 mg/dL men, >50 mg/dL women, ideally >60 mg/dL)
Lower is better (<100 mg/dL, or <70 mg/dL for high-risk individuals)
Role in cardiovascular health
Protective - transports cholesterol away from arteries to the liver for disposal
Atherogenic - deposits cholesterol in arterial walls, forming plaques
How to improve
Exercise, moderate alcohol, omega-3 fats, losing weight. Medications less effective.
Diet changes, weight loss, statins and other medications very effective
Response to lifestyle changes
Moderate improvement with exercise (5-10%)
Significant improvement with diet (10-20%) and medications (30-50%)

Key Differences

  • •HDL removes cholesterol from arteries; LDL deposits it
  • •Higher HDL is protective; lower LDL is protective
  • •LDL is the primary treatment target; HDL-raising hasn't shown clear benefits
  • •Exercise primarily improves HDL; diet and medications primarily lower LDL
  • •LDL directly causes atherosclerosis; HDL has complex, less direct effects

Why Both Matter

Both HDL and LDL cholesterol are important markers for cardiovascular risk, but they play opposite roles. LDL cholesterol is the primary driver of atherosclerosis - the process where plaques build up in artery walls, leading to heart attacks and strokes. This is why LDL is the main target for treatment.

HDL cholesterol helps remove excess cholesterol from tissues and artery walls, transporting it back to the liver for disposal (a process called reverse cholesterol transport). Higher HDL levels are associated with lower cardiovascular risk.

However, recent research has shown that the relationship isn't as simple as "good vs bad." Very high HDL (>100 mg/dL) may not provide additional protection and could even be harmful in some cases. The quality and function of HDL particles may matter more than quantity.

For most people, focusing on lowering LDL through diet, lifestyle, and medications when needed provides the clearest cardiovascular benefit. Maintaining reasonable HDL through exercise and healthy habits adds additional protection.

Learn more about

HDL Cholesterol

Measures "good" cholesterol that helps remove other forms of cholesterol from your bloodstream.

Learn more about

LDL Cholesterol

Measures "bad" cholesterol that can build up in your arteries.

Frequently Asked Questions

Which is more important to track - HDL or LDL?
LDL is generally more important because it directly causes atherosclerosis and is the primary treatment target. However, both provide valuable information about cardiovascular risk.
Can you have high HDL and still have heart disease?
Yes. While higher HDL is generally protective, it doesn't guarantee protection, especially if LDL is very high or other risk factors are present. HDL function may matter more than absolute levels.
Why do doctors focus more on lowering LDL than raising HDL?
Clinical trials consistently show that lowering LDL reduces heart attacks and strokes. Medications that raise HDL haven't shown the same clear benefits, suggesting HDL may be more of a marker than a direct cause of protection.
What is the ideal HDL to LDL ratio?
Rather than a ratio, absolute levels matter more. Aim for LDL <100 mg/dL (or <70 if high risk) and HDL >50 mg/dL. Total cholesterol to HDL ratio <4.5 is also a useful metric.

Track Both Markers Over Time

Upload your blood test results to BloodTrack and monitor both HDL Cholesterol and LDL Cholesterol. See how they change together over time.

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