Know Your Numbers #2: HDL
Last week, I said triglycerides tell you more when you put them next to another number on the same lab report.
This is that number: HDL.
You’ve probably heard it called “good” cholesterol. That nickname is half right, and the half that’s wrong matters.
What is HDL?
HDL stands for high-density lipoprotein. It isn’t cholesterol itself. It’s a particle that carries cholesterol through your blood.
Remember the delivery trucks from last week, carrying triglycerides out to your muscles and fat cells? HDL is the cleanup crew. It picks up extra cholesterol from your tissues, including your artery walls, and hauls it back to your liver.
That’s why it got the “good” label. People with low HDL have more heart attacks.
What’s a good number?
Here’s how HDL is usually graded (in mg/dL):
Men: under 40 is low
Women: under 50 is low
60 and up is generally considered protective
Low HDL is one of the five numbers in the Borderline Trap, also known as metabolic syndrome.
Here’s the edgy part: higher isn’t always better
For years, the thinking was simple. If HDL is good, raise it.
Drug companies tried. They built medications that pushed HDL way up. In large trials, the numbers went up and heart attacks didn’t come down.
Very high HDL, roughly 100 and up, hasn’t been shown to protect you either, and some studies suggest it may not be a good sign.
So what’s going on? HDL is less like a shield and more like a messenger. A low HDL usually travels with high triglycerides, extra weight around the middle, and a body that struggles to handle sugar. It’s a signal that your metabolism needs attention, not a number to chase with a pill.
What pushes HDL down
Sitting most of the day
A lot of sugar and refined carbs
Smoking
Extra fat around the belly
Trouble handling blood sugar (insulin resistance)
What helps bring it up
Regular movement, especially when it gets your heart rate up
Cutting back on sugar and refined carbs
Losing belly fat
Not smoking
Notice how much the two lists overlap with last week’s. That’s not an accident. Triglycerides and HDL usually move together, in opposite directions.
My numbers
On the night of my heart attack, my triglycerides were 111. “Normal.”
My HDL was 39. One point under the line for men.
One point. On paper, a rounding error. In real life, it was one more sign that my body wasn’t handling fuel well, and nobody connected it to anything.
In January 2026, my HDL was 84.
Same body. Different plate. A lot more movement.
Why these two numbers belong together
Triglycerides went from 111 to 47. HDL went from 39 to 84. They moved at the same time, in opposite directions, for the same reasons.
When you read them side by side, they tell you something neither one tells you alone. I walk through exactly how I read them, and what I look for, in my free webinar. I’ll send you the details soon.
What to ask at your next appointment
What’s my HDL, and how has it changed over the last few years?
If it’s low, what do you think is driving it?
Is my blood sugar or insulin part of the picture?
Can we look at my triglycerides and HDL together?
As always on Thursdays, the small things that matter:
This week's happiness check
Enjoyment: Reliving my mom’s trip to the Holy Land. It was on her bucket list, and in May 2023 she finally went, with all three of her kids beside her. What delighted her most wasn’t the places. It was having us all there. I’ve been sitting on 425GB of photos and videos from that trip for more than three years. New AI editing tools finally gave me a way in, and going through the footage has been pure joy.
Satisfaction: Writing Tuesday’s letter to the guy I was the week I got home from the hospital. It took me five years to know what to say.
Meaning: Hoping that letter reached someone in their first week home.
What your happiness check this week? Hit reply. I read every one.
Dennis
Cardiac Survivor · Your Friend in Recovery
Spokane, Washington
I’m a heart attack survivor, not a doctor. This is my personal experience and is for educational purposes only. Talk with your own care team before changing anything about your treatment.
P.S. Missed Know Your Numbers #1? Read the triglycerides issue here.
P.P.S. Have an appointment coming up? Grab my free list of the questions I wish I’d asked my cardiologist.