What is HDL Cholesterol? Men/Women Levels and How to Raise It

You’ve probably heard about good and bad cholesterol more times than you can count. But when you get your blood test results and see those numbers, do you really know what they mean for your health? HDL cholesterol is much more than a figure on a piece of paper. It is a direct indicator of how your body manages one of the most important processes for the health of your arteries. Having clarity about what levels you should reach and what you can do to improve them makes the difference between an effective prevention strategy and simply hoping everything will work out fine. The numbers matter, but understanding what lies behind them gives you control.

What is HDL Cholesterol

HDL cholesterol (high-density lipoprotein) is known as “good cholesterol” because it helps remove other forms of cholesterol from the bloodstream, carrying them back to the liver to be eliminated. Imagine microscopic particles between 7 and 12 nanometers in size — so small that you would need to line up more than 8,000 of them to span the thickness of a human hair. These are the densest of all the lipoproteins circulating in your blood.

Its structure is quite particular. At the center there is a core packed with cholesterol esters, surrounded by a layer of phospholipids, free cholesterol, and special proteins called apolipoproteins. The most important of these proteins is apolipoprotein A-I, which accounts for approximately 70% of the protein component of HDL. This protein is not there by chance: it is what allows HDL to capture the cholesterol it encounters along the way.

The “good” nickname is not just medical marketing. It comes from decades of clinical observation.

So how exactly does this arterial cleansing system work? The process is called reverse cholesterol transport and occurs in several coordinated phases. First, your liver and intestine produce free apolipoprotein A-I, which combines with phospholipids to form small, flat particles. These newly formed particles travel through your blood looking for cells that have an excess of cholesterol.

When they find a cell with too much cholesterol, two specialized transporters come into action: ABCA1 and ABCG1. The first is responsible for removing approximately 50% of the initial cholesterol from the cell, while the second contributes an additional 20%. Once loaded with cholesterol, the particles change shape, going from flat to spherical and becoming mature HDL.

The final destination is always the same: the liver. There, HDL delivers its entire cholesterol load, which your body converts into bile acids to be eliminated through the intestine.

But HDL does more than transport cholesterol. It also reduces inflammation in your arteries, protects LDL cholesterol from oxidizing, and prevents the formation of dangerous blood clots. That is why having adequate levels makes such a difference to your cardiovascular health.

Ideal HDL Levels

Maintaining high HDL levels reduces the risk of heart attacks and strokes. The exact numbers are more important than you might think.

Men: At Least 40 mg/dL

For men, the minimum threshold is set at 40 mg/dL. Below this figure you are already in the cardiovascular risk zone. The leading medical organizations, from the American Heart Association to the Cleveland Clinic and Mayo Clinic, agree on this cutoff point.

Women: At Least 50 mg/dL

In women, the minimum rises to 50 mg/dL. This difference is not arbitrary, nor does it reflect stricter standards for one gender over another. It has to do with how female hormones, especially estrogens, influence lipoprotein metabolism. That is why what is considered low in a woman (less than 50 mg/dL) may fall within the acceptable range for a man. It is a matter of physiology, not different standards.

Optimal Level: 60 mg/dL or More Is Considered Cardioprotective

Meeting the minimum is good, but reaching the optimal level is another matter. When your HDL reaches 60 mg/dL or more, you enter the territory of maximum cardiovascular protection. In fact, the ideal range extends to approximately 80 mg/dL.

Long-term follow-up data are clear. Men with HDL below 35 mg/dL have a 4.1 times greater risk of death from coronary heart disease than those with levels above 54 mg/dL. In women, having a low HDL (45 mg/dL) compared to values above 69 mg/dL multiplies the risk of coronary death by 3.1. Every point counts, literally.

For every increase of just 1 mg/dL in your HDL cholesterol, your cardiovascular risk decreases by approximately 2% if you are a man and 3% if you are a woman. Small increments with major consequences.

As for strokes, analyses involving nearly one million participants show that every increase of 39 mg/dL in HDL reduces the risk of ischemic stroke by 24% to 25%.

However, more is not always better. Levels above 90–100 mg/dL offer no additional protection and may even be associated with increased risk.

How to Raise HDL Naturally

If your levels are low, you can improve them with lifestyle changes. We are not talking about miracle solutions or overnight transformations, but about interventions that work and have solid scientific backing.

Regular Exercise

Regular physical activity is probably the most powerful intervention available to you. Each additional minute of aerobic exercise produces an increase of approximately 2.11 mg/dL in your HDL. The interesting thing is that you do not need to become an elite athlete.

The optimal intensity is between 65% and 85% of your maximum heart rate. What does that translate to? Imagine being able to hold a conversation but with some difficulty, without getting completely out of breath. Three or four weekly sessions of 30 to 45 minutes are enough to see results.

Aerobic exercise works better than resistance training for this specific goal.

Healthy Fats

Incorporating healthy fats into your diet makes a real difference. Avocado has been shown to increase HDL by an average of 2.84 mg/dL. One medium avocado provides about 13 grams of oleic acid, the monounsaturated fat that benefits your lipid profile so greatly. Walnuts, although their direct effect on HDL is more modest, improve the functionality of these lipoproteins and reduce the most dangerous LDL particles. Consuming between 30 and 60 grams daily is typical in protocols that show benefits.

Fatty fish such as salmon are another matter. The omega-3 fatty acids they contain can raise your HDL by up to 12%. Here is a detail many people are unaware of: fresh fish outperforms supplements in effectiveness. While fresh fish can increase your HDL by 8.51 mg/dL, supplements barely reach 4.47 mg/dL.

The general recommendation is to consume fatty fish at least twice a week, about 250 grams in total. Salmon, mackerel, sardines, or tuna are excellent options.

Foods rich in healthy fats that raise HDL:

Fatty fish (omega-3):

• Salmon
• Mackerel
• Sardines
• Tuna
• Trout
• Herring

Nuts and seeds:

• Walnuts (30-60g daily)
• Almonds
• Hazelnuts
• Pistachios
• Cashews
• Macadamia nuts

Avocado:

• 1 medium avocado daily (13g of oleic acid)

Healthy oils:

• Extra virgin olive oil
• Avocado oil
• Canola oil

Seeds:

• Chia seeds
• Flaxseeds
• Pumpkin seeds
• Sunflower seeds

Other:

• Olives
• Eggs (yolk rich in omega-3)
• Tofu and edamame

Recommended intake:

• Fatty fish: 2 times/week (250g total)
• Walnuts: 30-60g daily
• Avocado: 1 unit daily
• Olive oil: 2-3 tablespoons daily

Avoid Trans Fats

Trans fats are the number one enemy of your lipid profile. They not only raise LDL cholesterol by about 14 mg/dL, but also reduce HDL by approximately 7 mg/dL. It is a double blow that no other dietary component produces with such intensity.

High trans fat foods to avoid:

Packaged baked goods:

• Donuts
• Packaged croissants
• Packaged muffins
• Packaged pastries and palmiers
• Packaged cakes
• Cream-filled cookies

Processed snacks:

• Packaged potato chips
• Butter-flavored microwave popcorn
• Nachos and fried snacks
• Cheese puffs and similar snacks

Packaged bakery products:

• Packaged sandwich bread (some)
• Pre-made pizza bases
• Commercial puff pastry dough

Fast food:

• Fried chicken
• Chicken nuggets
• Fried onion rings
• French fries from fast food chains

Margarines and spreads:

• Stick margarines (not all)
• Non-dairy spreads

Pre-packaged foods:

• Frozen pizzas
• Packaged empanadas
• Pre-made croquettes
• Frozen breaded items

Creams and desserts:

• Non-dairy coffee creamers
• Packaged ice cream (some)
• Ready-made milkshakes

References

1. American Heart Association – Framingham Heart Study. High Density Lipoprotein Cholesterol and Mortality. Arteriosclerosis, Thrombosis, and Vascular Biology. Available at: https://www.ahajournals.org/doi/pdf/10.1161/01.atv.8.6.737
2. Centers for Disease Control and Prevention (CDC). Dose–Response Association Between High-Density Lipoprotein Cholesterol and Stroke: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Available at: https://www.cdc.gov/pcd/issues/2021/20_0278.htm
3. Cleveland Clinic. Cholesterol: Understanding Levels & Numbers. Available at: https://my.clevelandclinic.org/health/articles/11920-cholesterol-numbers-what-do-they-mean
4. Springer – Sports Medicine. The Effect of Exercise Training on Blood Lipids: A Systematic Review and Meta-analysis. Available at: https://link.springer.com/article/10.1007/s40279-024-02115-z
5. New England Journal of Medicine. Effect of Dietary trans Fatty Acids on High-Density and Low-Density Lipoprotein Cholesterol Levels in Healthy Subjects. Available at: https://www.nejm.org/doi/full/10.1056/nejm199008163230703