Editing High-density lipoprotein (section)

== Estimating HDL via associated cholesterol ==
Clinical laboratories formerly measured HDL cholesterol by separating other lipoprotein fractions using either ultracentrifugation or chemical precipitation with divalent ions such as Mg<sup>2+</sup>, then coupling the products of a cholesterol oxidase reaction to an indicator reaction. The reference method still uses a combination of these techniques.<ref>{{cite web|title=National Reference System for Cholesterol – Cholesterol Reference Method Laboratory Network – HDL Cholesterol Certification Protocol for Manufacturers|url=https://www.cdc.gov/labstandards/pdf/crmln/MFRHDLNov2002final.pdf|publisher=CDC|access-date=10 November 2013|archive-date=10 November 2013|archive-url=https://web.archive.org/web/20131110213548/http://www.cdc.gov/labstandards/pdf/crmln/MFRHDLNov2002final.pdf|url-status=live}}</ref> Most laboratories now use automated homogeneous analytical methods in which lipoproteins containing [[Apolipoprotein B|apo B]] are blocked using antibodies to apo B, then a [[Colorimetry (chemical method)|colorimetric]] enzyme reaction measures cholesterol in the non-blocked HDL particles.<ref>{{cite journal | vauthors = Warnick GR, Nauck M, Rifai N | title = Evolution of methods for measurement of HDL-cholesterol: from ultracentrifugation to homogeneous assays | journal = Clinical Chemistry | volume = 47 | issue = 9 | pages = 1579–1596 | date = Sep 2001 | doi = 10.1093/clinchem/47.9.1579 | pmid = 11514391 | url = http://www.clinchem.org/content/47/9/1579.full | access-date = 2013-11-10 | archive-url = https://web.archive.org/web/20140313071220/http://www.clinchem.org/content/47/9/1579.full | archive-date = 2014-03-13 | url-status = dead | doi-access = free }}</ref> [[High-performance liquid chromatography|HPLC]] can also be used.<ref>{{cite journal | vauthors = Okazaki M, Sasamoto K, Muramatsu T, Hosaki S | title = Evaluation of precipitation and direct methods for HDL-cholesterol assay by HPLC | journal = Clinical Chemistry | volume = 43 | issue = 10 | pages = 1885–90 | date = Oct 1997 | doi = 10.1093/clinchem/43.10.1885 | pmid = 9342008 | url = http://www.clinchem.org/cgi/content/abstract/43/10/1885 | access-date = 2009-10-08 | archive-url = https://web.archive.org/web/20080724115339/http://www.clinchem.org/cgi/content/abstract/43/10/1885 | archive-date = 2008-07-24 | url-status = dead | doi-access = free }}</ref> Subfractions (HDL-2C, HDL-3C) can be measured,<ref>{{cite journal | vauthors = Hirano T, Nohtomi K, Koba S, Muroi A, Ito Y | title = A simple and precise method for measuring HDL-cholesterol subfractions by a single precipitation followed by homogenous HDL-cholesterol assay | journal = Journal of Lipid Research | volume = 49 | issue = 5 | pages = 1130–6 | date = May 2008 | pmid = 18223297 | doi = 10.1194/jlr.D700027-JLR200 | doi-access = free }}</ref> but clinical significance of these subfractions has not been determined.<ref name="pmid23312047">{{cite journal | vauthors=Superko HR, Pendyala L, Williams PT, Momary KM, King SB 3rd, Garrett BC | title=High-density lipoprotein subclasses and their relationship to cardiovascular disease | journal=[[Journal of Clinical Lipidology]] | volume=6 | issue=6 | year=2012 | pages=496–523 | doi = 10.1016/j.jacl.2012.03.001 | pmid=23312047}}</ref>  The measurement of apo-A reactive capacity can be used to measure HDL cholesterol but is thought to be less accurate.{{citation needed|date=March 2021}}

=== Recommended ranges ===
The [[American Heart Association]], [[NIH]] and [[National Cholesterol Education Program|NCEP]] provide a set of guidelines for fasting HDL levels and risk for [[Coronary heart disease|heart disease]].<ref>{{cite web
| url=http://www.americanheart.org/presenter.jhtml?identifier=4500
| title=Cholesterol Levels
| publisher=American Heart Association
| access-date=14 November 2009
| archive-url=https://web.archive.org/web/20100208054234/http://www.americanheart.org/presenter.jhtml?identifier=4500
| archive-date=8 February 2010
}}</ref><ref>{{cite web
| url=http://www.americanheart.org/downloadable/heart/119618151049911%20CholLevels%209_07.pdf
| title=What Do My Cholesterol Levels Mean?
| publisher=American Heart Association
|date = September 2007| access-date=14 November 2009
| archive-url=https://web.archive.org/web/20081203122456/http://www.americanheart.org/downloadable/heart/119618151049911%20CholLevels%209_07.pdf
| archive-date=3 December 2008
}}</ref><ref>{{cite web
|url=http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf
|title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Executive Summary
|date=May 2001
|work=National Heart, Lung, and Blood Institute (NHLBI)
|publisher=National Institutes of Health
|access-date=2009-12-03
|archive-date=2009-08-02
|archive-url=https://web.archive.org/web/20090802002640/http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf
|url-status=live
}}</ref>

{| class="wikitable"
|-
! Level mg/dL
! Level [[Mole (unit)|mmol]]/L
! Interpretation
|-
| <40 (men), <50 (women)
| <1.03 (men), <1.29 (women)
| Low HDL cholesterol, considered correlated for heart disease (heightened risk)
|-
| 40–59 (men), 50–59 (women)
| 1.03–1.55 (men), 1.29–1.55 (women)
| Medium HDL level
|-
| >59
| >1.55
| High HDL level, optimal condition considered correlated against heart disease
|}
High LDL with low HDL level is an additional risk factor for cardiovascular disease.<ref>ASHWOOD, E. R., BURTIS, C. A., & BRUNS, D. E. (2008). Tietz fundamentals of clinical chemistry. (6th ed., p. 415). St. Louis, MO: Saunders Elsevier.</ref>