High density lipoprotein (or HDL for short) is also known as “good cholesterol.” It picks up extra cholesterol in the blood and returns it to the liver. Low density lipoprotein (or LDL) is also known as “bad cholesterol.” It is the main transporter of cholesterol in the body. But too much LDL over many years can result in atherosclerosis (the narrowing and hardening of arteries) and lead to heart disease or a heart attack.

The ratio of HDL/LDL looks at the ratio of good cholesterol (HDL) to bad cholesterol (LDL). The ratio is determined by dividing the LDL cholesterol into the HDL cholesterol. For example, if a person has an HDL cholesterol of 50 mg/dL and an LDL cholesterol of 150 mg/dL, the HDL/LDL ratio would be 0.33. The goal is to keep the ratio above 0.3, with the ideal HDL/LDL ratio being above 0.4.

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High-density lipoproteins. These lipoproteins are often referred to as HDL, or “good,” cholesterol. They act as cholesterol scavengers, picking up excess cholesterol in your blood and taking it back to your liver for disposal. The higher your HDL level, the less “bad” cholesterol you’ll have in your blood. In addition, HDL may have other protective effects on your heart and blood vessels, including antioxidant, anti-inflammatory and anti-clotting effects.

Low-density lipoproteins. These lipoproteins carry cholesterol throughout your body, delivering it to different organs and tissues. But if your body has more cholesterol than it needs, the excess keeps circulating in your blood. Over time, circulating LDL cholesterol reduces in size and undergoes chemical changes (becomes oxidized). These smaller, denser particles more easily enter the blood vessel wall and start to build up under the vessel lining. Deposits of LDL cholesterol particles are called plaques, and they can lead to inflammation, bleeding into the area, and calcification. Eventually, plaques can start to crowd the space within the blood vessel and obstruct blood flow, causing coronary artery disease. This is why LDL cholesterol is often referred to as “bad” cholesterol.

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HDL cholesterol, or “good” cholesterol, appears to scour the walls of blood vessels, cleaning out excess cholesterol. It then carries that excess cholesterol — which otherwise might have been used to make the “plaques” that cause coronary artery disease — back to the liver for processing. So when we measure a person’s HDL cholesterol level, we seem to be measuring how vigorously his or her blood vessels are being “scrubbed” free of cholesterol.

HDL levels below 40 mg/dL result in an increased risk of coronary atery disease, even in people whose total cholesterol and LDL cholesterol levels are normal. HDL levels between 40 and 60 mg/dL are considered “normal.” However, HDL levels greater than 60 mg/dL may actually protect people from heart disease. Indeed, for several years, doctors have known that when it comes to HDL levels, the higher the better.

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