HDL Cholesterol

Introduction

As a Nurse Practitioner in autonomous practice in Florida, I’ve had the opportunity to engage with patients on various aspects of their health. One biomarker that often comes up in discussions about cardiovascular health is High-Density Lipoprotein (HDL) cholesterol. Often referred to as the “good cholesterol,” HDL plays a crucial role in our body’s lipid metabolism and offers protective benefits against cardiovascular diseases. This article aims to provide a comprehensive understanding of HDL cholesterol, including its background, clinical implications, and factors influencing its levels.

Background on HDL Cholesterol

HDL cholesterol is a lipoprotein composed primarily of phospholipids and apoproteins. Unlike its counterpart, Low-Density Lipoprotein (LDL), which transports cholesterol to peripheral tissues, HDL functions to transport cholesterol from the peripheral tissues and vessel walls back to the liver. This reverse transport mechanism is essential for processing and metabolizing cholesterol into bile salts, which are then excreted from the body.

The protective benefits of HDL are significant due to its ability to interfere with the absorption and binding of LDL by smooth muscle and other cells, thereby reducing the risk of atherosclerosis. Additionally, HDL acts as an antioxidant and a free radical scavenger, further protecting cells from oxidative damage.

HDL Cholesterol Ranges

Understanding the ranges of HDL cholesterol is important for interpreting lipid profiles:

• Standard Range: 45.00 – 100.00 mg/dL (1.16 – 2.59 mmol/L)
  
• Optimal Range: 55.00 – 93.00 mg/dL (1.42 – 2.40 mmol/L)
  
  

These ranges provide a reference for determining whether HDL cholesterol levels are within a healthy range. When evaluating HDL levels, it’s essential to consider them in relation to total cholesterol and LDL cholesterol levels. A decreased HDL level is not considered a cardiovascular risk if the total cholesterol is low. However, if the total cholesterol is elevated, HDL can serve as a strong independent diagnostic indicator for atherosclerotic coronary artery disease.

Clinical Implications of Low HDL Levels

Hyperlipidemia and Atherosclerosis

If HDL is less than 25% of the total cholesterol, there is a strong clinical indication of hyperlipidemia, which may lead to atherosclerosis. Increased serum triglycerides and LDL levels further support this diagnosis.

Diets High in Refined Carbohydrates

The Standard American Diet (SAD), characterized by high refined carbohydrate intake, can contribute to decreased HDL levels. Adjusting dietary habits is crucial for managing HDL levels.

Metabolic Syndrome and Hyperinsulinemia

Decreased HDL levels, coupled with increased triglycerides, LDL cholesterol, and fasting blood glucose, may indicate metabolic syndrome and hyperinsulinemia. These conditions are associated with adrenal dysregulation and should be addressed promptly.

Oxidative Stress

HDL cholesterol acts as an antioxidant, so decreased levels can increase the risk of oxidative stress and free radical–induced diseases, including lipid peroxidation.

Heavy Metal and Chemical Overload

Patients with historically low HDL levels may be more susceptible to heavy metal and chemical toxins due to poor cell membrane integrity. This susceptibility can increase the risk of developing neoplasms.

Fatty Liver/Steatosis and Liver Congestion

Low HDL levels, along with increased LDL, triglyceride, and total cholesterol levels, may indicate fatty liver development. This condition can impair the liver’s detoxification ability and increase the risk of insulin resistance, hypertension, and type II diabetes mellitus.

Hyperactive Thyroid

Increased metabolic activity in hyperthyroidism can lead to decreased HDL levels, as the body uses fatty acids for energy.

Lack of Exercise

A sedentary lifestyle has been shown to decrease HDL levels, highlighting the importance of regular cardiovascular and resistance exercise.

Clinical Implications of High HDL Levels

While high HDL levels are generally considered protective, excessively high levels can also have implications:

Autoimmune Processes

Increased HDL cholesterol, along with decreased triglycerides and low or normal total cholesterol, may suggest an autoimmune process. Further testing for tissue inflammation or destruction is warranted.

Other Conditions

Factors such as genetic predisposition, excessive exercise, and endocrine dysfunction may contribute to significantly increased HDL levels in otherwise healthy patients.

Interfering Factors

Certain factors can interfere with the measurement of HDL levels:

• Falsely Decreased Levels: Ascorbic acid may cause a 5–15% decrease in HDL levels. Temporary decreases can also occur after a myocardial infarction.
  
• Falsely Increased Levels: None noted.
  
  

Drug Associations

Various medications can influence HDL levels:

• Drug Causes of Decreased Levels: Thiazide diuretics, beta-blockers without sympathomimetic activity, steroids.
  
• Drug Causes of Increased Levels: Antihypertensive medications, estrogen, estrogen in combination with androgens, sympatholytic agents.
  
  

Conclusion

In conclusion, a comprehensive evaluation by a functional medicine practitioner in Florida facilitates identification of cellular and molecular imbalances driving cardiometabolic dysfunction. By integrating evidence-based allopathic therapies with longevity medicine services—where lipid optimization and vascular health are prioritized—we offer a preventive framework to rebuild resilience and optimize wellness. Call (904) 799-2531 or schedule online to request your personalized cardiovascular health assessment.

Further Reading

1. Rohatgi A, et al. HDL cholesterol efflux capacity and incident cardiovascular events. N Engl J Med. 2014;371(25):2383–2393. PubMed
   
2. Voight BF, et al. Plasma HDL cholesterol and risk of myocardial infarction: a Mendelian randomization study. Lancet. 2012;380(9841):572–580. PubMed
3. Barter PJ, et al. Cholesterol efflux capacity, HDL function, and atherosclerosis. N Engl J Med. 2007;356(11):1253–1262. PubMed