HDL of 65 mg/dL: Interpretation and Clinical Significance
An HDL cholesterol level of 65 mg/dL is protective and associated with reduced cardiovascular risk, requiring no intervention directed at raising HDL further. 1
What This Level Means
Your HDL of 65 mg/dL is well above the threshold that indicates increased cardiovascular risk:
- Men: HDL <40 mg/dL indicates increased risk 1, 2
- Women: HDL <45-50 mg/dL indicates increased risk 1
- Your level of 65 mg/dL: Protective across all populations 1, 3
Epidemiological studies consistently demonstrate that each 10 mg/dL increase in HDL cholesterol reduces stroke risk by 11-15%, and your level falls comfortably in the protective range. 1
Clinical Action: Focus on LDL, Not HDL
Do not pursue HDL-raising therapy, as there are no established HDL treatment targets and multiple trials attempting to raise HDL pharmacologically have failed to demonstrate cardiovascular benefit. 2, 1
Instead, your cardiovascular risk management should focus on:
Primary Target: LDL Cholesterol
Your LDL cholesterol goal depends on your cardiovascular risk category 1:
- Very high risk (documented CVD, diabetes with organ damage): LDL <70 mg/dL 1
- High risk (2+ risk factors, 10-20% 10-year CHD risk): LDL <100-130 mg/dL 1
- Moderate risk (0-1 risk factors): LDL <160 mg/dL 1
Secondary Target: Non-HDL Cholesterol (if triglycerides >200 mg/dL)
Non-HDL cholesterol targets are 30 mg/dL higher than corresponding LDL targets, capturing remnant lipoprotein risk 1, 4:
Important Clinical Context
HDL levels remain predictive of cardiovascular events even when LDL is optimally controlled. In patients with LDL <70 mg/dL on statin therapy, those in the highest HDL quintile still had lower cardiovascular event rates than those in the lowest quintile. 3 However, this does not translate into a recommendation to raise HDL pharmacologically—it simply confirms HDL's role as a risk marker, not a treatment target. 2
What Maintains Healthy HDL
If you want to maintain or modestly improve your already-protective HDL level through lifestyle 1:
- Weight management: Obesity inversely correlates with HDL2 subfraction 5
- Physical activity: Regular exercise supports HDL metabolism 1
- Smoking cessation: Smoking lowers HDL 6
- Moderate alcohol consumption (if appropriate): Positively correlates with HDL3 subfraction 5
The bottom line: Your HDL of 65 mg/dL is excellent and requires no specific intervention. Direct your attention to achieving appropriate LDL cholesterol targets based on your overall cardiovascular risk profile. 2, 1