Affinity Health, a leading provider of quality health cover, says that although HDL cholesterol is often called “good” cholesterol, an unusually high result does not necessarily mean a person is better protected against heart disease.

For years, the message was simple. LDL cholesterol is bad, and HDL cholesterolis good, but newer research suggests the relationship is more complicated. A healthy HDL level is generally linked to a lower risk of heart disease, yet extremely high levels may not add any extra protection, and in some people, they may even be linked to a higher risk.

“It is understandable that many people feel reassured when they see a high HDL result, but every cholesterol number must be considered as part of the bigger picture rather than focusing on a single number,” says Murray Hewlett, CEO of Affinity Health.

“As we understand it, factors such as LDL cholesterol, triglycerides, blood pressure, blood sugar, age, lifestyle, family history, and existing health conditions all play a part, which is why we encourage people to discuss their results with a healthcare professional.”

What Does HDL Cholesterol Do?

Cholesterol is a waxy substance that the body needs to build healthy cells and produce hormones, vitamin D, and bile acids, which help digest fats.

Because cholesterol cannot travel through the blood on its own, it is carried inside particles called lipoproteins.

High density lipoprotein, or HDL, helps carry excess cholesterol from the bloodstream and tissues back to the liver, which can then reuse it or help remove it from the body. HDL particles may also help reduce inflammation and act as antioxidants, which helps protect the walls of blood vessels.

This is why HDL earned the nickname “good” cholesterol. Even so, a standard blood test only measures how much cholesterol is being carried by HDL particles. It does not show the number, size, or quality of those particles, or how well they are working.

When Is HDL Considered Very High?

Cholesterol is usually measured in millimoles per litre, written as mmol/L.

An HDL level above approximately 1.0 mmol/L in men and 1.2 mmol/L in women is generally considered favourable. Laboratories may use slightly different reference ranges, though, and what counts as ideal depends on the person’s overall health.

An HDL level above approximately 2.3 mmol/L is considered extremely high in some international guidance. This does not automatically mean something is wrong, but it may need further assessment, particularly when other risk factors are present.

A person can have high HDL while also having raised LDL cholesterol, high triglycerides, diabetes, high blood pressure, or a strong family history of early heart disease. High HDL does not cancel out these risks.

Why Might Very High HDL Be a Concern?

Studies suggest that both very low and extremely high HDL levels may be linked to health risks. Researchers are still trying to understand why.

One possibility is that very high HDL may not work as well as it should. It may become less effective at carrying excess cholesterol away from the arteries and protecting blood vessels.

Very high HDL may also be linked to a person’s genes, medicines, lifestyle, or another health condition. This means it may be a warning sign of another problem rather than the direct cause.

Research has found a link between extremely high HDL and some health risks. Even so, it has not proved that high HDL directly causes heart attacks, strokes, dementia, or other conditions.

What Can Cause Very High HDL?

Some people naturally have high HDL because of inherited genetic differences affecting the way their bodies produce, transfer, or remove cholesterol.

Other possible causes include:

• Heavy alcohol consumption.
• An overactive thyroid gland.
• Certain liver or bile duct conditions.
• Medicines such as corticosteroids, insulin, or phenytoin.
• Rare inherited cholesterol disorders.

Regular exercise and diets containing healthy unsaturated fats may also raise HDL, but these changes are usually modest and form part of a lifestyle that’s good for the heart.

If an HDL result is unexpectedly high, a healthcare professional may repeat the test and review the person’s medicines, alcohol intake, family history, thyroid function, liver health, and complete cholesterol profile.

What Is Generally Recommended?

There is no standard treatment to lower HDL alone. The focus is on reducing the overall risk of a heart attack or stroke.

A high HDL result is generally not considered a reason to stop exercising or cut healthy fats from your diet. Staying active, avoiding smoking, limiting alcohol, and eating more vegetables, fruit, beans, lentils, wholegrains, nuts, and seeds are widely recognised as part of a heart-healthy lifestyle. Cutting back on foods high in saturated and trans fats is commonly recommended, and conditions such as high blood pressure or diabetes are best managed with the help of a healthcare professional.

High HDL does not cancel out raised LDL, which can cause fatty plaque to build up in the arteries, increasing the risk of a heart attack or stroke.

Conclusion

HDL cholesterol plays a valuable role in the body, but “the higher, the better” is no longer considered an accurate rule. An extremely high result is not automatically dangerous, but it should be read alongside the complete cholesterol profile and the person’s overall health. Affinity Health offers members access to 24/7 Telehealth GP consultations, unlimited managed visits to a Medical Society, and a wide network of healthcare providers, making it easier to discuss cholesterol concerns and arrange a blood test to check HDL and other cholesterol levels when necessary.

About Affinity Health

Affinity Health is South Africa’s leading health cover provider, offering a range of options at affordable rates, including access to the widest national provider network. We understand how important it is to have medical insurance that fits your needs, your budget, and your lifestyle. Our healthcare products are designed to protect you and your family when it matters most. We strive to give our members peace of mind and the highest standard of service. For more information, follow us on Facebook, Instagram, and X.