Lab marker
HDL-C
HDL cholesterol · High-density lipoprotein cholesterol
Inversely associated with cardiovascular risk in cohort data — but raising it pharmacologically does not reduce events.
What it measures
Cholesterol cargo carried by high-density lipoprotein particles. Historically considered cardio-protective; modern evidence is more nuanced.
Reference context
2 guideline sources
Very high HDL-C (>90 mg/dL / 2.3 mmol/L) is paradoxically associated with elevated mortality in some cohorts — the U-shape is real.
Population context — consult guideline targets below
Mechanism
Why moving this marker matters
HDL particles participate in reverse cholesterol transport. Population-level inverse association with CV risk is robust, but Mendelian-randomisation and HDL-raising drug trials (CETP inhibitors, niacin) failed to demonstrate the expected mortality benefit, suggesting HDL-C is a marker of underlying processes more than a causal mediator.
Guideline targets
What major guidelines recommend
Common reference (men, low risk)
>40 mg/dL (>1.0 mmol/L)
Common reference (women, low risk)
>48 mg/dL (>1.2 mmol/L)
How to measure
The test, where to get it, when to repeat
Method
Standard lipid panel.
Where
Standard GP panel everywhere.
Typical cost
Bundled with the lipid panel.
Fasting
Not required
When to test
ESC 2021
40+Part of routine cardiovascular risk assessment from age 40.
Where to test
Independent labs offering this test
Healicus refers you to independent laboratories. You order from the lab; they take the sample, run it, and return your result on their own platform. Healicus never sees your value.
Randox Health
UK · EU · INTLClinic-based premium panels — wider biomarker breadth than home-test brands.
Visit Randox Health
Synlab
DE · EU · INTLEurope-wide medical lab network — referrals via partner GPs and direct-to-consumer programmes where offered.
Visit Synlab
Medichecks
UKUKAS-accredited home blood-test panels with GP-equivalent biomarker coverage.
Visit Medichecks
Thriva
UKApp-first subscription home testing, capillary draw, clinician-reviewed reports.
Visit Thriva
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Context
Reading the numbers
Very high HDL-C (>90 mg/dL / 2.3 mmol/L) is paradoxically associated with elevated mortality in some cohorts — the U-shape is real.
Caveats
Lifestyle (exercise, weight loss, smoking cessation) raises HDL-C modestly. Don't pursue HDL-C as a treatment target.
Practices
What's been shown to influence this marker
Aerobic exercise reliably raises HDL-C by ~3–8 mg/dL with sustained training (Kodama 2007 meta-analysis); dose-dependent on duration and intensity. Pharmacological HDL-raising has not shown mortality benefit.
Zone 2 cardio
Habit·Conversational-pace cardio, 150+ minutes per week. Mitochondrial backbone of healthspan.
Why
Zone 2 is the intensity at which you can still hold a conversation but a song would be a stretch — roughly 60–70% of max heart rate. Sustained Zone 2 work increases mitochondrial density, improves fat oxidation, and is the single most consistently associated exercise input with all-cause mortality reduction in cohort studies.
Slot in your day
How to do it
How
Brisk walk, easy bike, slow jog. 30 minutes × 5 days, or 45–60 min × 3 days. The 'talk test' is the simplest gauge.
Ideal for
Anyone over 30; especially valuable as the foundation before adding higher-intensity work.
Sticking with it
Schedule it like a meeting. The session you 'fit in if there's time' is the session that doesn't happen.
Markers this may influence
Evidence
Weekly VO₂ max intervals
Program·One session/week of 4×4 minute intervals; raises VO₂ max — strongly correlated with longevity.
Why
VO₂ max (maximum oxygen uptake) is among the strongest single physiological correlates of all-cause mortality. The Norwegian 4×4 protocol (4 min hard, 3 min easy, ×4) is the most-studied intervention to raise it. One session per week is enough for meaningful improvement; more risks under-recovery.
The program
- 1
Warm up 10 minutes at easy pace.
- 2
4 minutes at ~90% max HR — very hard, can speak only short phrases.
- 3
3 minutes easy recovery.
- 4
Repeat the 4-minute hard / 3-minute easy block 4 times total.
- 5
Cool down 5-10 minutes.
- 6
Once per week — more risks under-recovery.
Practical
Cadence
Once per week
What you'll need
A solid Zone-2 base (12+ weeks of regular cardio)
Ideal for
People with a Zone 2 base who want to push their cardiovascular ceiling.
Markers this may influence
Evidence
See also
Related markers
Take to your physician
Worth discussing
- Whether your HDL-C, paired with TG, suggests metabolic syndrome.
- Why pharmacological HDL-C raising isn't generally pursued.
- How exercise and weight loss affect your HDL-C trajectory.
Sources
Cited literature
Edited by Carl Pöhl, MD · Healicus editorial
Last reviewed May 2026
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