HDL and LDL Cholesterol

Get the facts on the good (HDL), bad (LDL) and ugly (triglycerides) cholesterol

Despite its reputation, not all cholesterol is bad. And in fact, it’s essential for bodily function — in healthy doses, of course.

Cholesterol is a waxy, fat-like substance produced by your liver and found in your bloodstream. It helps your body build cells and produce certain hormones and vitamin D.

Your body makes all the cholesterol it needs to function, but you also can get it from your diet. And while your body needs it, too much cholesterol in your bloodstream can lead to serious heart health problems like coronary artery disease, heart attack and stroke.

“What matters most is achieving the right balance between ‘good’ and ‘bad’ cholesterol,” says Alexa Mieses Malchuk, MD, a board-certified family medicine physician at Geisinger. “Cholesterol is typically a silent disease and won’t cause any noticeable symptoms. But regular cholesterol checks to monitor your numbers help you stay in control of your risk for heart disease.”

And if your numbers are high, know that you’re not stuck with them. You and your doctor can develop a treatment plan to get your numbers — and heart health — back in check.

What’s the difference between HDL and LDL cholesterol?

Knowing the difference between good and bad cholesterol is key to managing the health of your heart and blood vessels.

There are 2 main types of cholesterol:

LDL (low-density lipoprotein) cholesterol: Considered “bad” cholesterol because it can lead to arterial plaque buildup and the narrowing of your arteries, which increases blood pressure and your risk of heart attack and stroke
HDL (high-density lipoprotein) cholesterol: Considered “good” cholesterol because it helps clean up “bad” cholesterol from your arteries and carries it back to your liver, where it processes the excess cholesterol and removes it from your body, lowering your heart disease risk

Besides cholesterol, you also have triglycerides in your bloodstream — the most common type of fat in your body. Triglycerides store excess energy (in fat cells) from your diet to be used later. Eating more calories than you burn causes triglycerides to build up, which can lead to arterial hardening and raise your risk for heart disease.

“A high triglyceride level combined with high LDL cholesterol or low HDL cholesterol is linked with fatty buildups within the artery walls and increases your risk of heart attack and stroke,” says Dr. Mieses Malchuk. “Balancing HDL and LDL cholesterol, and monitoring triglycerides levels, helps you keep your cholesterol under control.”

So, what are healthy cholesterol levels?

You can monitor your numbers through regular cholesterol checks. The American Heart Association recommends a cholesterol check every 4 to 6 years for low-risk adults over age 20. But if you’re at higher risk or over age 40, you’ll need a cholesterol check more often.

“A cholesterol check is an easy blood test called a lipid panel that measures the different fats in your blood: HDL, LDL and triglyceride levels,” explains Dr. Mieses Malchuk. “Based on your results, you and your doctor can determine if treatment is necessary.”

Healthy cholesterol levels

Your total cholesterol is the sum of all blood cholesterol, including both LDL and HDL. Readings can range from:

Optimal: Below 200 mg/dL
Borderline high: Levels between 200 and 239 mg/dL
High: 240 mg/dL and above

But it’s also important to monitor cholesterol components to get a complete picture of your heart health.

Healthy LDL cholesterol levels

“Bad” cholesterol should be kept low and readings can range from:

Optimal: Below 100 mg/dL, but 100-129 mg/dL is considered healthy
Borderline high: Levels between 130 and 159 mg/dL
High: 160 mg/dL and above

Healthy HDL cholesterol levels

Conversely, you want to keep “good” cholesterol high and readings can range from:

Optimal: 60 mg/dL or higher
Low: Below 40 mg/dL in men and 50 mg/dL in women

Healthy triglyceride levels

Triglyceride readings can range from:

Optimal: Below 150 mg/dL
Borderline high: Levels between 150 and 199 mg/dL
High: 200 mg/dL and above

These are general guidelines. Your results and target numbers will depend on your age, family history, weight and sex.

“Cholesterol levels are only one part of the story,” says Dr. Mieses Malchuk. “So if your numbers fall outside the normal range, don’t panic. Talk to your doctor about which cholesterol levels are healthy for you and what steps you can take to get there.”

How to lower your cholesterol

Often, the first line of treatment for high cholesterol involves adopting a heart-healthy lifestyle. While there are some factors you cannot change like age, sex and family history, there are many factors you can change to lower your risk.

“Changing what you put into your body and moving more can significantly improve your health and lower your cholesterol,” says Dr. Mieses Malchuk. ”It’s best to eat more polyunsaturated fat (often found in plants) and less saturated fat, which is found in animal products like meat, eggs and dairy and some plants like coconuts. But it’s not all or nothing, it’s about balance.”

To help improve your cholesterol numbers:

Eat more whole foods. Incorporating more fruits, vegetables, whole grains and healthy fats (polyunsaturated fats) like salmon, olive oil and avocado into your diet can increase your HDL and reduce cholesterol absorption in your bloodstream.
Limit saturated and trans fats. Eating less packaged and deep-fried foods, red meat and processed meats like bacon and sausage, and full-fat dairy products can lower your LDL.
Exercise regularly. Engaging in at least 150 minutes of physical activity weekly, such as brisk walking, jogging, cycling or swimming, and strength training on 2 or more days can raise HDL cholesterol and lower triglycerides.
Quit smoking. Cigarette smoking increases your LDL and lowers your HDL levels, which contributes to higher cholesterol and heart disease risk factors. The effects on your cholesterol are almost immediate after quitting.
Limit alcohol. Excessive alcohol consumption can increase LDL cholesterol and triglycerides and negatively impact your heart health.

Sometimes, lifestyle changes alone aren’t enough to lower your cholesterol and medications might be necessary. Statins are commonly prescribed to reduce cholesterol production in the liver, but there are other medications (and even some supplements) that can help.

“If you don’t know your numbers, get your cholesterol checked and discuss your results with your family physician,” says Dr. Mieses Malchuk. “Knowledge is power. Your cholesterol numbers are a good indicator of your heart disease risk and can tell you whether action is necessary.”