What does the research show about hdl cholesterol (hdl-c)?

HDL cholesterol (HDL-C)

HDL cholesterol is the cholesterol carried in HDL particles. Sources call levels below 40 mg/dL low, with 50 mg/dL used for women in one definition. Higher levels go with less heart disease in cohorts, but genetic studies and trials of drugs that raised HDL mostly found no fewer heart attacks. Extremely high levels were tied to more deaths.

Checked 2026-11-13

Status: Part of the standard lipid panel, ordered by a clinician and also sold direct to consumers by some US laboratories. FDA classifies lipoprotein test systems as class I devices exempt from premarket notification, and its product classification also lists over-the-counter HDL cholesterol tests [1].
Measures: The amount of cholesterol carried in high-density lipoprotein particles in blood.
Also called: HDL-C, HDL, HDL cholesterol, high-density lipoprotein cholesterol, high density lipoprotein, HDL chol, HDL direct, direct HDL, good cholesterol
Tested for: heart attack risk, stroke risk, cholesterol check, metabolic syndrome, good cholesterol, cholesterol ratio

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Linked in research2

StrongLinked to less coronary heart disease at higher levels, about 22% less for each 15 mg/dL higher across 68 pooled cohorts.
LimitedTwo Danish cohorts linked both low and extremely high HDL cholesterol to more deaths, with the lowest risk at 73 mg/dL in men and 93 mg/dL in women.

Reported risks0

No risks sourced yet.

Reference ranges

Each range is the one its source published, in mg/dL. Also reported in mmol/L. Where sources differ, each is shown.

National Cholesterol Education Program, Adult Treatment Panel III, 2001

Adults aged 20 and older · [2]

Range	What the source calls it
below 40 mg/dL	"low"
40 to 59 mg/dL	No name given
60 or above mg/dL	"high"

The panel defined low HDL cholesterol as below 40 mg/dL, raised from below 35 mg/dL in its earlier report, and counted it as a risk factor for coronary heart disease. It counted 60 mg/dL or above as a "negative" risk factor that removes one risk factor from a person's count, which is why this page places that band inside the panel's reference and not above it. The panel names no band for 40 to 59 mg/dL and set no goal for raising HDL cholesterol, stating that the evidence was insufficient [2].

American Heart Association and American College of Cardiology cholesterol guideline, 2018, metabolic syndrome factor, men

Men, as one of the factors that define the metabolic syndrome · [3], [2]

Range	What the source calls it
below 40 mg/dL	"low HDL-C"
40 or above mg/dL	No name given

The guideline lists low HDL cholesterol among five metabolic syndrome factors and states that a tally of three makes the diagnosis. Adult Treatment Panel III used the same level [2]. The guideline sets no HDL cholesterol treatment target. It converts cholesterol to mmol/L by dividing mg/dL by 38.6 [3], and a European guideline uses 1 mmol/L to 38.67 mg/dL [4]. A 2026 guideline from the same US bodies retires and replaces this one [5].

American Heart Association and American College of Cardiology cholesterol guideline, 2018, metabolic syndrome factor, women

Women, as one of the factors that define the metabolic syndrome · [3], [2]

Range	What the source calls it
below 50 mg/dL	"low HDL-C"
50 or above mg/dL	No name given

European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine consensus on laboratory reporting, 2016

Adults, fasting or not, as a value for laboratories to flag on reports · [6]

Range	What the source calls it
40 or below mg/dL	"abnormal"
above 40 mg/dL	No name given

The statement asks laboratories to flag results against desirable concentration cut points in place of a population reference interval. The cut point is 1 mmol/L, and the statement adds that sex-specific cut points can be used. The authors estimate that 10% of adults in a typical Western or Northern European country would be flagged [6].

National Heart, Lung, and Blood Institute expert panel, 2011, children and adolescents

Children and adolescents · [7]

Range	What the source calls it
below 40 mg/dL	"low"
40 to 45 mg/dL	"borderline"
above 45 mg/dL	"acceptable"

Values come from an earlier US pediatric cholesterol panel. The low cut point represents approximately the 10th percentile [7].

National Heart, Lung, and Blood Institute expert panel, 2011, young adults

Young adults, from data on people aged 20 to 24 · [7]

Range	What the source calls it
below 40 mg/dL	"low"
40 to 44 mg/dL	"borderline low"
above 45 mg/dL	"acceptable"

Values come from the Lipid Research Clinics Prevalence Study. The low cut point represents roughly the 25th percentile and the acceptable band values above the 50th percentile. The panel's table prints the borderline band as 40 to 44 mg/dL and the acceptable band as above 45 mg/dL, which leaves a result of exactly 45 mg/dL in neither band [7].

What has been shown to move it

Shown to lower it7

OrlistatStrong

Cholesterol and blood lipids

Shown to lower total and LDL cholesterol slightly, by about 0.3 mmol/L, with larger drops when more weight was lost.

HDL cholesterol fell 0.034 mmol/L and triglycerides 0.09 mmol/L.

The numbers and sources

Effect: Orlistat lowered total cholesterol by 0.30 mmol/L and LDL cholesterol by 0.27 mmol/L. HDL cholesterol fell 0.034 mmol/L and triglycerides 0.09 mmol/L. Lipoprotein(a) did not change. LDL lowering was larger with more weight loss and shorter treatment [3]. An earlier systematic review also found greater falls in total and LDL cholesterol than with control [5].
Population: 33 RCTs [3]; 28 RCTs, 17 of them with 10,041 patients over a year [5].
Sources: [3], [5]
Caveats: The changes are small. The reviews do not separate the drug from the weight lost.

Vegetarian dietStrong

LDL cholesterol

Shown to lower LDL cholesterol about 0.3 mmol/L against omnivorous diets in adults. HDL also fell slightly in one review.

Compared with control diets the source does not describe [2]; an omnivorous control diet containing meat and dairy products [3]; an omnivorous diet [4]

The numbers and sources

Effect: In 11 trials, vegetarian diets lowered total cholesterol by 0.36 mmol/L, LDL by 0.34 mmol/L (95% CI -0.57 to -0.11) and HDL by 0.10 mmol/L (95% CI -0.14 to -0.06), with no triglyceride change [3]. In 30 RCTs, vegetarian or vegan diets lowered LDL by 0.30 mmol/L (95% CI -0.40 to -0.19) and apolipoprotein B by 12.92 mg/dL, with similar effects across intervention diet types and no triglyceride change [4]. In people with diabetes, LDL fell 0.12 mmol/L (95% CI -0.20 to -0.04) [2].
Population: Adults in randomized trials [3][4]; adults with diabetes [2].
Sources: [2], [3], [4]
Caveats: The reviews pooled lacto-ovo and vegan diets, though [4] found effects similar across diet types.

IsotretinoinModerateVery common

Raised triglycerides and cholesterol

Shown to raise triglycerides markedly in 25% of people in trials, lower HDL in 15% and raise cholesterol in 7%. The changes reversed after stopping.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In clinical trials, marked rises in serum triglycerides occurred in 25%, falls in HDL in 15% and rises in cholesterol in 7%, reversing after the drug was stopped. Triglycerides above 800 mg/dL have been reported, and the rise is dose related [3]. A meta-analysis found statistically significant changes in mean lipid values during treatment, with means of 119.98 mg/dL for triglycerides and 184.74 mg/dL for total cholesterol, and found the mean changes did not reach its high-risk thresholds and few people had abnormal results [9].
Population: Isotretinoin capsule trials [3]; 1,574 patients aged 9 to 35 in 26 studies [9].
Sources: [3], [9]
Caveats: The meta-analysis abstract gives values during treatment, not the size of the change from baseline [9]. The label states the heart consequences are unknown [3].

ResveratrolModerate

Inflammation and blood lipids

Mixed results: reviews disagree on whether CRP falls, and most found no change in LDL or triglycerides.

HDL fell slightly (WMD -4.18 mg/dL, 95% CI -6.54 to -1.82).

The numbers and sources

Effect: One meta-analysis found no change in CRP (WMD -0.144 mg/L, 95% CI -0.968 to 0.680), total cholesterol, LDL, triglycerides or glucose. HDL fell slightly (WMD -4.18 mg/dL, 95% CI -6.54 to -1.82) [4]. A later meta-analysis found lower TNF-α (WMD -0.44, 95% CI -0.71 to -0.16) and hs-CRP (WMD -0.27, 95% CI -0.5 to -0.02), with no change in IL-6 [6]. In 25 RCTs in metabolic disorders, CRP fell (SMD -0.18, 95% CI -0.33 to -0.03), and IL-6 and TNF-α did not change significantly [7]. In 6 RCTs in type 2 diabetes (533 participants), CRP fell (SMD -1.40, 95% CI -2.60 to -0.21) [8]. Apolipoprotein B (WMD 2.11 mg/dL, 95% CI -1.53 to 5.75) and apolipoprotein A-I did not change in 7 RCTs [9]. An umbrella review rated as high certainty a 0.19 mmol/L drop in total cholesterol in adults with overweight (95% CI 0.06 to 0.32) [5].
Population: 10 RCTs [4]; 17 RCTs with 736 adults [6]; adults with metabolic disorders [7]; adults with type 2 diabetes [8]; 7 RCTs [9]; meta-analyses of RCTs [5].
Sources: [4], [6], [7], [8], [9], [5]
Caveats: The reviews disagree on CRP, and the CRP effect in [8] is several times the size of that in [7]. Heterogeneity in [6] was about 50%. Evidence in [8] was low certainty. CRP is a marker, not a clinical outcome [7].

SARMsGrey marketModerateHow often is not known

Lower testosterone and HDL cholesterol

Shown to lower testosterone and HDL cholesterol in healthy men, more at higher doses. Levels returned to baseline after stopping.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: LGD-4033 lowered total testosterone, sex hormone-binding globulin, HDL cholesterol and triglycerides in a dose-dependent way. FSH and free testosterone fell at the highest dose. Levels returned to baseline after stopping [1]. The 2026 review reports suppression of testosterone, sex hormone-binding globulin and HDL cholesterol across randomized trials, with reversible rises in liver enzymes for some compounds [4].
Population: 76 healthy young men over 21 days and 5 weeks of follow-up [1]; trials summarized in a review [4].
Sources: [1], [4]
Caveats: Trial doses were lower and shorter than the stacked, unmonitored use the review describes [4].

CLALimitedStudied in menHow often is not known

Insulin resistance with the trans-10 cis-12 isomer

One trial found the purified trans-10 cis-12 isomer raised insulin resistance by 19% in 60 obese men. The commercial mixture did not change glucose metabolism.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In 60 abdominally obese men given 3.4 g a day for 12 weeks, purified trans-10 cis-12 CLA raised insulin resistance by 19% and blood glucose by 4%, and lowered HDL cholesterol by 4%, compared with placebo. The commercial isomer mixture did not change glucose metabolism and lowered HDL by 2% [6].
Population: 60 men with signs of the metabolic syndrome, measured by euglycemic clamp [6].
Sources: [6]
Caveats: One trial. Pooled trials of CLA with exercise found insulin resistance lower, not higher [5].

Ezetimibe and fenofibrateLimitedHow often is not known

Fenofibrate: paradoxical drop in HDL

Case reports: the label reports rare severe drops in HDL cholesterol, as low as 2 mg/dL, after starting fibrates, which reversed after stopping.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Postmarketing and trial reports describe HDL falling as low as 2 mg/dL, mirrored by a fall in apolipoprotein A1, from 2 weeks to years after starting a fibrate, with rapid recovery after stopping [7].
Population: Diabetic and nondiabetic patients in reports [7].
Sources: [7]
Caveats: Reports without a denominator. On average HDL rose in trials.

Shown to raise it19

BerberineStrong

Cholesterol and triglycerides

Shown to lower LDL by about 0.46 mmol/L and lower triglycerides in adults, in trials mostly from China and Hong Kong.

The numbers and sources

Effect: In 18 placebo-controlled trials (1,788 participants), berberine lowered LDL by 0.46 mmol/L (95% CI -0.62 to -0.30), total cholesterol by 0.48 mmol/L and triglycerides by 0.34 mmol/L, and raised HDL by 0.06 mmol/L. The HDL rise was seen in women and not in men [8]. A 27-trial meta-analysis found berberine combined with lipid drugs lowered cholesterol more than the drugs alone [4].
Population: Adults, mostly in mainland China and Hong Kong, for 4 to 24 weeks [8].
Sources: [4], [8]
Caveats: 15 of the 18 trials were in mainland China or Hong Kong [8].

EggsStrong

HDL cholesterol and the cholesterol ratio

Shown to raise HDL cholesterol slightly in feeding trials. The ratio of LDL or total cholesterol to HDL rose in two of three pooled analyses.

Compared with diets differing only in dietary cholesterol or number of eggs [2]; control groups eating fewer eggs [3][4]

The numbers and sources

Effect: Each extra 100 mg of dietary cholesterol a day raised HDL by 0.3 mg/dL (95% CI 0.2 to 0.4), total cholesterol by 2.2 mg/dL and the total to HDL cholesterol ratio by 0.020 units (95% CI 0.010 to 0.030) [2]. Across 66 trials, eggs raised HDL and apolipoprotein A1 along with total and LDL cholesterol, with no change in the LDL to HDL ratio [4]. Across 17 trials in healthy people, eating more eggs raised the LDL to HDL ratio by 0.14 (P = 0.001) [3].
Population: 556 participants in 17 controlled feeding studies of at least 14 days [2]. 3,185 participants in 66 randomized trials [4]. Healthy participants in 17 randomized trials [3].
Sources: [2], [4], [3]
Caveats: The pooled analyses disagree on the ratio. Trials ran weeks to months and measured blood lipids, not heart events.

Ezetimibe and fenofibrateStrong

Ezetimibe: LDL cholesterol and ApoB

Shown to lower LDL cholesterol about 18% more than placebo when taken alone, with ApoB about 16% lower, and to lower LDL further when added to a statin.

Compared with placebo [1][2]; a statin or fenofibrate alone [3][4]

The numbers and sources

Effect: Across 8 placebo-controlled 12-week trials, ezetimibe 10 mg lowered LDL cholesterol 18.58% more than placebo (95% CI 17.48 to 19.67), total cholesterol 13.46% more and triglycerides 8.06% more, and raised HDL cholesterol 3.00% [1]. In two label trials, LDL cholesterol fell 18% and ApoB 16% on ezetimibe against a 1% rise and 2% fall on placebo [2]. Added to a statin or fenofibrate, ezetimibe lowered LDL cholesterol, total cholesterol and triglycerides further and likely raised HDL [3]. After an acute coronary syndrome, time-averaged LDL was 53.7 mg/dL on simvastatin with ezetimibe against 69.5 mg/dL on simvastatin alone [4].
Population: 2,722 people with primary hypercholesterolemia in 8 trials [1]; 1,719 adults in two trials [2]; 23,499 people in 26 trials [3]; 18,144 patients [4].
Sources: [1], [2], [3], [4]
Caveats: Lipid trials alone lasted 12 weeks [1]. Heterogeneity was substantial in the combination analyses [3].

GarlicStrong

Cholesterol

Shown to lower total cholesterol about 10 to 17 mg/dL and LDL about 6 to 9 mg/dL in adults, more in those with high cholesterol.

A 2026 meta-analysis of 108 trials (7,137 adults) found total cholesterol fell 10.21 mg/dL (95% CI -13.69 to -6.74), LDL 5.90 mg/dL, and triglycerides 5.82 mg/dL, while HDL rose 2.18 mg/dL.

The numbers and sources

Effect: Across 39 trials, garlic lowered total cholesterol by 17 ± 6 mg/dL and LDL by 9 ± 6 mg/dL in people with total cholesterol above 200 mg/dL, when taken for longer than 2 months. HDL rose slightly and triglycerides did not change significantly [3]. A 2026 meta-analysis of 108 trials (7,137 adults) found total cholesterol fell 10.21 mg/dL (95% CI -13.69 to -6.74), LDL 5.90 mg/dL, and triglycerides 5.82 mg/dL, while HDL rose 2.18 mg/dL [4].
Population: Adults in 39 trials, effects reported in those with elevated cholesterol [3]. Adults in 108 trials [4].
Sources: [3], [4]
Caveats: The abstract of [3] describes earlier meta-analyses on this question as conflicting. The authors of [4] report larger effects in adults with unfavorable baseline risk factors and call for larger, longer, more rigorous trials. The two reviews disagree on triglycerides.

Keto dietStrong

Triglycerides and HDL cholesterol

Shown to lower triglycerides by about 0.2 to 0.3 mmol/L and raise HDL cholesterol more than comparison diets in adults.

Compared with diets that did not restrict carbohydrates to the level of ketosis

The numbers and sources

Effect: Against low-fat diets over 12 months or more, triglycerides fell 0.18 mmol/L more (95% CI 0.08 to 0.27) and HDL rose 0.09 mmol/L more (95% CI 0.06 to 0.12) [1]. Across 27 RCTs, triglycerides fell 0.20 mmol/L (95% CI 0.11 to 0.29) and HDL rose 0.16 mmol/L (95% CI 0.09 to 0.23) against control diets [2]. In 62 studies, triglycerides fell 19.96 mg/dL (95% CI 13.81 to 26.10) and HDL rose 3.61 mg/dL (95% CI 1.44 to 5.57) [5]. In pre-diabetes and type 2 diabetes, triglycerides were 0.28 mmol/L lower at 12 months (95% CI 0.11 to 0.44) [6].
Population: Adults with and without obesity or type 2 diabetes [1][2][5][6].
Sources: [1], [2], [5], [6]
Caveats: Heterogeneity was 72.2% for triglycerides and 86.7% for HDL in [2]. The same reviews found LDL cholesterol rose (see Risks).

Soy foodsStrong

LDL cholesterol

Shown to lower LDL cholesterol by about 4.8 mg/dL, 3% to 4%, at a median 25 g of soy protein a day against non-soy protein, in pooled trials.

Compared with non-soy protein [4]; control groups the abstract does not describe [5]

In 23 trials of soy protein with its isoflavones intact, total cholesterol fell 3.77%, LDL cholesterol 5.25% and triglycerides 7.27%, and HDL cholesterol rose 3.03%.

The numbers and sources

Effect: Across 41 trials identified by the FDA, soy protein at a median 25 g a day for a median 6 weeks lowered LDL cholesterol by 4.76 mg/dL (95% CI -6.71 to -2.80) and total cholesterol by 6.41 mg/dL (95% CI -9.30 to -3.52), with no dose-response or publication bias. About 75% of trials showed a fall, though few were individually significant [4]. In 23 trials of soy protein with its isoflavones intact, total cholesterol fell 3.77%, LDL cholesterol 5.25% and triglycerides 7.27%, and HDL cholesterol rose 3.03%. Falls were larger in men and in people with high cholesterol. Tablets of extracted isoflavones did not lower total cholesterol [5].
Population: Adults with baseline LDL cholesterol of 110 to 201 mg/dL in 43 trials [4]. 23 randomized trials published 1995 to 2002 [5].
Sources: [4], [5]
Caveats: Heterogeneity was moderate (I² 55% for LDL) [4]. Most trials lasted weeks. The FDA has proposed revoking the soy protein heart claim [1], which the review authors attribute to a perceived lack of consistent LDL reduction in trials [4].

TurmericStrong

Cholesterol and triglycerides

Shown to lower triglycerides about 13 mg/dL and LDL about 6 mg/dL in adults with metabolic conditions. Smaller reviews found no significant LDL change.

Curcumin lowered LDL cholesterol by 5.84 mg/dL (95% CI -11.63 to -0.05), triglycerides by 13.15 mg/dL (95% CI -17.31 to -8.98) and total cholesterol by 7.76 mg/dL, and raised HDL by 2.4 mg/dL.

The numbers and sources

Effect: An umbrella review re-pooled 72 RCTs. Curcumin lowered LDL cholesterol by 5.84 mg/dL (95% CI -11.63 to -0.05), triglycerides by 13.15 mg/dL (95% CI -17.31 to -8.98) and total cholesterol by 7.76 mg/dL, and raised HDL by 2.4 mg/dL [10]. In 27 RCTs in prediabetes and diabetes, triglycerides fell 13.73 mg/dL, total cholesterol 5.24 mg/dL and LDL 5.72 mg/dL (95% CI -8.62 to -2.82), and HDL rose 2.14 mg/dL [11]. In 11 RCTs (662 people with metabolic disease), triglycerides and total cholesterol fell, while LDL and HDL did not change significantly under random-effects models [12]. With piperine added, 16 RCTs (1,038 participants) showed lower triglycerides and total cholesterol and no significant LDL change [13].
Population: Adults with noncommunicable diseases, with larger effects in type 2 diabetes [10]; adults with prediabetes or diabetes [11]; adults with metabolic disorders [12][13].
Sources: [10], [11], [12], [13]
Caveats: I² was 94% to 98% in the umbrella review [10] and above 80% in the diabetes review, which rated certainty low for every outcome [11]. The LDL drop did not reach significance in two smaller reviews [12][13]. The umbrella review found the total cholesterol and HDL changes smaller than their minimal clinically important differences [10].

Added sugarModerateHow often is not known

Blood fats and blood pressure

Shown to raise triglycerides, total and LDL cholesterol and blood pressure in trials of higher against lower sugar intake, independent of body weight.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Higher sugar intake raised triglycerides by 0.11 mmol/L (95% CI 0.07 to 0.15), total cholesterol by 0.16 mmol/L (95% CI 0.10 to 0.24), LDL cholesterol by 0.12 mmol/L (95% CI 0.05 to 0.19) and HDL cholesterol by 0.02 mmol/L (95% CI 0.00 to 0.03). In trials of 8 weeks or longer, systolic pressure rose 6.9 mmHg (95% CI 3.4 to 10.3) and diastolic 5.6 mmHg [11]. A liter of regular cola a day for 6 months raised triglycerides 32% and total cholesterol 11% more than milk, diet cola or water [12].
Population: 37 trials reporting lipids and 12 reporting blood pressure, each at least 2 weeks [11]. 47 overweight adults [12].
Sources: [11], [12]
Caveats: Heterogeneity was moderate to high (I² 36% to 75%) [11]. The cola trial was small.

AlcoholModerate

HDL cholesterol in trials

Shown to raise HDL cholesterol by about 0.09 mmol/L in trials of adults without heart disease, with no change in triglycerides.

Compared with periods without alcohol [9]

The numbers and sources

Effect: Alcohol raised HDL cholesterol (mean difference 0.094 mmol/L, 95% CI 0.064 to 0.123), apolipoprotein A1 (0.101 g/L, 95% CI 0.073 to 0.129) and adiponectin, with a dose-response for HDL. It lowered fibrinogen (-0.20 g/L) and did not change triglycerides. Results were similar for wine, beer and spirits [9].
Population: 44 interventional studies of 13 markers in adults without known cardiovascular disease [9].
Sources: [9]
Caveats: These are blood markers, not heart attacks. The review calls them indirect support for a protective effect [9], while genetic studies of heart disease found none (see above).

AstaxanthinModerate

Blood sugar and blood lipids

Shown to lower fasting glucose by about 16 mg/dL and triglycerides in people with prediabetes or type 2 diabetes. Reviews disagree on LDL and total cholesterol.

The numbers and sources

Effect: In prediabetes and type 2 diabetes, astaxanthin lowered fasting glucose by 16.1 mg/dL (95% CI -29.0 to -3.3), HbA1c by 0.34 points, triglycerides by 20.9 mg/dL, total cholesterol by 12.2 mg/dL and LDL by 9.4 mg/dL, and raised HDL by 3.0 mg/dL. HOMA-IR, weight and BMI did not change [4]. At 6 to 20 mg a day, a second meta-analysis found higher HDL and lower triglycerides, with no change in LDL or total cholesterol [5]. In adults at risk of metabolic syndrome, effects on total cholesterol and systolic pressure were marginal, and LDL fell [6].
Population: 403 patients in 9 RCTs [4]; 8 studies with 11 results [5]; 321 adults in 7 RCTs [6].
Sources: [4], [5], [6]
Caveats: The reviews disagree on LDL and total cholesterol. All pooled small trials.

Ezetimibe and fenofibrateModerate

Fenofibrate: triglycerides, HDL and LDL cholesterol

Shown to lower triglycerides about 29% and LDL cholesterol 21% and to raise HDL 11% against placebo, with triglycerides 46% to 55% lower in severe high triglycerides.

Compared with placebo [7]

The numbers and sources

Effect: In four placebo-controlled trials of 3 to 6 months, fenofibrate at the 145 mg dose changed triglycerides by -28.9% against +7.7% on placebo, LDL cholesterol by -20.6% against -2.2%, total cholesterol by -18.7% against -0.4%, and HDL by +11.0% against +0.7%. ApoB fell 25.1% against a 2.4% rise. In severe high triglycerides, triglycerides fell 46.2% (baseline 432 mg/dL) and 54.5% (baseline 726 mg/dL) against -0.5% and +7.2% on placebo, while LDL cholesterol rose in both groups [7].
Population: 646 adults with high cholesterol or mixed dyslipidemia in 4 trials, and 147 adults with high triglycerides in 2 trials of 8 weeks [7].
Sources: [7]
Caveats: Label trials, short-term. The label reports rare severe paradoxical drops in HDL, listed under Risks [7].

FenugreekModerate

Blood lipids

Shown to lower total cholesterol and triglycerides and raise HDL in controlled trials, more in people with diabetes. Sources disagree on LDL.

The numbers and sources

Effect: Across 15 RCTs, fenugreek lowered total cholesterol (-1.13, 95% CI -1.88 to -0.37), LDL (-1.26, 95% CI -2.09 to -0.43) and triglycerides (-1.07) and raised HDL (0.70, 95% CI 0.07 to 1.34) compared with control. Effects were larger in people with diabetes [3]. The 2023 diabetes meta-analysis reported lower total cholesterol and triglycerides, higher HDL, and no change in LDL [2].
Population: 281 people on fenugreek and 255 controls in controlled trials [3].
Sources: [2], [3]
Caveats: The sources disagree on LDL. The abstract of [3] does not state the units of its pooled estimates.

Fisetin and quercetin (senolytics)Moderate

Liver enzymes and lipids in fatty liver disease (quercetin alone)

Shown to lower liver enzymes, LDL and triglycerides with quercetin alone in people with fatty liver disease, at very low to moderate certainty.

The numbers and sources

Effect: A 2025 meta-analysis of 7 RCTs (540 patients) with metabolic dysfunction-associated steatotic liver disease found that quercetin lowered ALT, AST, GGT, direct bilirubin and C-reactive protein, lowered total cholesterol, LDL and triglycerides, and raised HDL. BMI, body fat, kidney function and TNF-α did not change [10].
Population: 540 patients with fatty liver disease in 7 RCTs [10].
Sources: [10]
Caveats: GRADE certainty ranged from very low to moderate. Dose, baseline BMI and age may explain heterogeneity. The abstract gives no pooled effect sizes [10]. None of the trials measured senescent cells.

Garcinia cambogiaModerate

Cholesterol and triglycerides

Shown to lower triglycerides about 24 mg/dL and raise HDL slightly in adults, with no LDL change. One 10-week trial found no lipid change.

The numbers and sources

Effect: Across 14 trials with 623 subjects, total cholesterol fell 6.76 mg/dL (95% CI -12.39 to -0.59), triglycerides fell 24.21 mg/dL (95% CI -37.84 to -10.58) and HDL rose 2.95 mg/dL (95% CI 2.01 to 3.89). LDL did not change (-1.15 mg/dL, 95% CI -16.08 to 13.78). Changes were larger in trials longer than 8 weeks [5]. In the 10-week Korean trial, garcinia extract did not change triglycerides or total cholesterol compared with placebo [4].
Population: Adults in 14 RCTs [5]; 86 overweight adults [4].
Sources: [4], [5]
Caveats: Interventions were short and heterogeneity was significant [5].

NiacinModerate

Blood lipids

Shown to raise HDL and lower triglycerides and LDL in people with vascular disease on statins, though events did not fall.

The numbers and sources

Effect: At 2 years in AIM-HIGH, median HDL rose from 35 to 42 mg/dL, triglycerides fell from 164 to 122 mg/dL and LDL fell from 74 to 62 mg/dL on 1,500 to 2,000 mg a day of extended-release niacin [1]. In HPS2-THRIVE, LDL averaged 10 mg/dL lower and HDL 6 mg/dL higher than placebo [2].
Population: 3,414 people with cardiovascular disease on simvastatin [1]; 25,673 adults with vascular disease on statin-based therapy [2].
Sources: [1], [2]
Caveats: Lipid changes did not translate into fewer events in these trials (see next block).

Olive oilModerate

Cholesterol

Shown to raise HDL cholesterol slightly in trials. LDL fell with high-polyphenol olive oil, but other plant oils lowered LDL more than olive oil did.

Compared with other plant oils [9]; low-polyphenol olive oil [10][11]

The numbers and sources

Effect: Against other plant oils, olive oil raised HDL more (1.37 mg/dL, 95% CI 0.4 to 2.36) and lowered total cholesterol (by 6.27 mg/dL), LDL (by 4.2 mg/dL, 95% CI 1.4 to 7.01) and triglycerides (by 4.31 mg/dL) less. Apolipoproteins A1 and B did not differ [9]. Against low-polyphenol olive oil, high-polyphenol oil lowered total cholesterol by 4.5 mg/dL and raised HDL by 2.37 mg/dL [10]. A later pooling found higher HDL (1.13 mg/dL, 95% CI 0.45 to 1.80), lower LDL only at the highest polyphenol level (-4.28 mg/dL) and no change in total cholesterol [11].
Population: 1,089 participants in 27 randomized trials [9]. 26 randomized trials [10]. 10 randomized trials, mostly crossover, in mostly healthy Europeans [11].
Sources: [9], [10], [11]
Caveats: The changes are a few mg/dL. The comparison decides the direction: olive oil looks favorable against low-polyphenol olive oil and less favorable for LDL against other plant oils.

StatinsModerate

LDL cholesterol lowering

Shown to lower LDL cholesterol by about 51 to 56 mg/dL with atorvastatin and rosuvastatin, and triglycerides by about 25 to 32 mg/dL.

Triglycerides fell by 24.76 and 31.98 mg/dL, and HDL rose by 1.85 and 3.87 mg/dL.

The numbers and sources

Effect: Pooled across studies, atorvastatin lowered LDL cholesterol by 51.49 mg/dL (95% CI 42.75 to 60.23) and rosuvastatin by 55.66 mg/dL (95% CI 46.32 to 65.00). Triglycerides fell by 24.76 and 31.98 mg/dL, and HDL rose by 1.85 and 3.87 mg/dL [3].
Population: Studies of atorvastatin and rosuvastatin from 2003 to 2025 [3].
Sources: [3]
Caveats: The abstract does not give study counts, doses or the comparison used. The heart attack and stroke results above are expressed per unit of LDL lowered [1].

YogaModerate

Blood sugar and blood fats in type 2 diabetes

Shown in one meta-analysis to lower HbA1c by 0.47 points and fasting glucose by 24 mg/dL in adults with type 2 diabetes, with high heterogeneity.

Compared with control groups including usual care or standard treatment [12]

The numbers and sources

Effect: Pooled differences were -23.72 mg/dL for fasting blood glucose (95% CI -37.78 to -9.65, I² 82%), -0.47% for HbA1c (95% CI -0.87 to -0.07, I² 82%), -17.38 mg/dL for glucose after meals, -18.50 mg/dL for total cholesterol, +4.30 mg/dL for HDL cholesterol and -12.95 mg/dL for LDL cholesterol. Triglycerides did not differ (-12.57 mg/dL, 95% CI -29.91 to 4.76) [12].
Population: 864 adults with type 2 diabetes in 12 trials [12].
Sources: [12]
Caveats: The authors note limited methods and heterogeneity, and long-term effects were not studied [12].

GrapefruitLimited

Cholesterol

Mixed results: one trial found HDL cholesterol rose with grapefruit against a water preload, while another found no difference in blood lipids against a control diet.

Compared with a control diet low in fruits and vegetables [4]; a water preload matched for weight and calories [5]

The numbers and sources

Effect: Over 12 weeks, HDL cholesterol changed by +6.2% with grapefruit and +8.2% with grapefruit juice preloads, against -3.7% with water (significant) [5]. Over 6 weeks, lipids did not differ between the grapefruit and control groups, though total cholesterol fell 11.7 mg/dL and LDL cholesterol 18.7 mg/dL from baseline in the grapefruit group [4].
Population: 85 obese adults on calorie restriction [5]. 74 overweight adults [4].
Sources: [5], [4]
Caveats: Two small trials with different comparisons. Changes from baseline within one group do not show an effect of grapefruit when the control group is not different [4].

Studies disagree3

Physical activityStrong

Blood fats

Shown to lower triglycerides in pooled trials of aerobic training, with HDL cholesterol rising modestly in two reviews and not changing overall in a third.

Compared with control groups in randomized trials [8][9]; no exercise, or diet alone [10]

The numbers and sources

Effect: HDL cholesterol rose by 2.53 mg/dL against controls, from a minimum of about 120 minutes of exercise a week, and rose more with longer sessions [8]. In sedentary adults with metabolic syndrome factors, aerobic training lowered triglycerides by 0.17 to 0.18 mmol/L, total cholesterol by 0.19 to 0.29 mmol/L and LDL cholesterol by 0.12 to 0.20 mmol/L, and raised HDL cholesterol by 0.05 to 0.10 mmol/L [9]. In adults with overweight or obesity, aerobic exercise lowered triglycerides and did not change total, HDL or LDL cholesterol overall [10].
Population: 25 randomized trials [8]. 2,990 participants in 48 data sets of trials of at least 12 weeks [9]. 619 adults with overweight or obesity in 9 trials [10].
Sources: [8], [9], [10]
Caveats: Changes were modest. The populations differed across reviews, which may explain the HDL difference.

Red meat and processed meatModerate

Cholesterol and blood pressure in trials

Not shown to change cholesterol or blood pressure against all comparison diets combined. Against plant proteins, LDL fell less on red meat. Against fish, it fell more.

Compared with diets replacing red meat with legumes, soy or nuts, fish, poultry, mixed animal protein, refined carbohydrates or the usual diet [4]

Against fish, LDL fell 0.173 mmol/L more and HDL 0.065 mmol/L more.

The numbers and sources

Effect: Against all comparison diets combined, red meat made no significant difference to total, LDL or HDL cholesterol, apolipoproteins A1 and B, or blood pressure, and gave a smaller fall in triglycerides (0.065 mmol/L). Against high-quality plant proteins, total cholesterol fell 0.264 mmol/L less and LDL 0.198 mmol/L less. Against fish, LDL fell 0.173 mmol/L more and HDL 0.065 mmol/L more. Against refined carbohydrates, triglycerides fell 0.181 mmol/L more [4].
Population: 1,803 participants in 36 randomized trials [4].
Sources: [4]
Caveats: The result depends on what replaced the red meat. Trials measured blood markers, not heart events.

Tai chi and qigongModerate

Blood fats in hypertension

Shown in two meta-analyses to lower LDL cholesterol and triglycerides in people with hypertension. HDL cholesterol results differed between them.

Compared with control groups the source abstract does not describe [5]; no intervention [6]

Baduanjin lowered triglycerides and LDL cholesterol and raised HDL cholesterol against no intervention.

The numbers and sources

Effect: Tai chi was associated with lower total cholesterol (WMD -0.49), triglycerides (WMD -0.49, 95% CI -0.92 to -0.07) and LDL cholesterol (WMD -0.86), and no significant effect on HDL cholesterol (P = 0.16) [5]. Baduanjin lowered triglycerides and LDL cholesterol and raised HDL cholesterol against no intervention [6].
Population: Adults with essential hypertension [5][6].
Sources: [5], [6]
Caveats: The first abstract gives no units, and its HDL interval does not contain its own point estimate [5]. The second gives no sizes for blood fats [6].

Tested, and not shown to change it22

Apple cider vinegarStrong

Cholesterol

Shown to lower total cholesterol by about 6 mg/dL in adults, with no change in LDL or HDL.

The numbers and sources

Effect: ACV lowered total cholesterol by 6.06 mg/dL (95% CI -10.95 to -1.17) with no significant effect on LDL or HDL [2]. A 2025 meta-analysis of 25 trials found total cholesterol 6.72 mg/dL lower (95% CI -12.91 to -0.53, I² 50.8%), with no significant change in LDL, HDL or triglycerides [4].
Population: Adults in 9 studies [2]. 1,320 adults in 25 trials [4].
Sources: [2], [4]
Caveats: Triglyceride reductions appeared only in subgroups [2][4].

Beta-glucanStrong

LDL cholesterol (oat beta-glucan)

Shown to lower LDL by about 0.2 to 0.25 mmol/L in adults at 3 g a day or more of oat beta-glucan.

The numbers and sources

Effect: In 28 trials, 3 g a day or more of oat beta-glucan lowered LDL by 0.25 mmol/L (95% CI 0.20 to 0.30) and total cholesterol by 0.30 mmol/L, with no change in HDL or triglycerides. Dose (3.0 to 12.4 g a day) and duration (2 to 12 weeks) did not change the result [1]. In 58 trials (3,974 people), a median 3.5 g a day lowered LDL by 0.19 mmol/L (95% CI 0.14 to 0.23), non-HDL by 0.20 mmol/L and apoB by 0.03 g/L [2].
Population: Adults, mostly with normal to raised cholesterol [1][2].
Sources: [1], [2]
Caveats: LDL heterogeneity was high in [2] (I² 79%). [1] was supported by DSM Nutritional Products and searched in-house reports at CreaNutrition, a subsidiary of an oat fiber company. FDA's health claim rests on 3 g a day or more from whole oats or barley [3].

Fiber supplementsStrong

LDL cholesterol

Shown to lower LDL cholesterol by about 0.33 mmol/L with about 10 g of psyllium a day in adults with or without high cholesterol.

The numbers and sources

Effect: Across 28 trials (1,924 participants), a median 10.2 g of psyllium a day lowered LDL cholesterol by 0.33 mmol/L (95% CI -0.38 to -0.27), non-HDL cholesterol by 0.39 mmol/L and apoB by 0.05 g/L (95% CI -0.08 to -0.03) [1]. A 2025 meta-analysis of 41 RCTs (2,049 participants) found LDL cholesterol 8.55 mg/dL lower (95% CI -12.92 to -4.19) and total cholesterol 9.05 mg/dL lower. Triglycerides and HDL did not change significantly [2].
Population: Adults with or without high cholesterol in RCTs of 3 weeks or longer [1]; adults in 41 RCTs [2].
Sources: [1], [2]
Caveats: LDL and non-HDL estimates were graded moderate quality because of inconsistency, and apoB high quality [1]. Heterogeneity in the 2025 review was considerable (I² 88% for LDL), and dose and duration did not explain it [2].

GlucomannanStrong

LDL cholesterol

Shown to lower LDL cholesterol by about 10%, about 16 mg/dL, in adults and children. Changes were not significant in adults with insulin resistance.

The numbers and sources

Effect: Across 14 studies with 531 participants, glucomannan lowered total cholesterol 19.28 mg/dL (95% CI -24.30 to -14.26), LDL 15.99 mg/dL (95% CI -21.31 to -10.67) and triglycerides 11.08 mg/dL (95% CI -22.07 to -0.09), with no change in HDL [1]. Across 12 studies with 370 participants, LDL fell 0.35 mmol/L (95% CI -0.46 to -0.25) and non-HDL cholesterol 0.32 mmol/L, about 10% and 7%. Apolipoprotein B did not change in 6 trials [2].
Population: Adults and children in RCTs [1][2].
Sources: [1], [2]
Caveats: Trials were small and short, with follow-up of at least 3 weeks in [2]. In 11 trials restricted to adults with insulin resistance-related conditions, lipid changes were not significant overall, with LDL and total cholesterol lower only in subgroups above 3,000 mg a day or at 4 weeks or less [3].

Green tea extractStrong

LDL cholesterol

Shown to lower LDL cholesterol slightly, about 2 mg/dL, and total cholesterol about 7 mg/dL in adults, with no HDL change.

HDL did not change.

The numbers and sources

Effect: Across 14 RCTs (1,136 subjects), green tea beverages or extracts lowered total cholesterol by 7.20 mg/dL (95% CI -8.19 to -6.21) and LDL cholesterol by 2.19 mg/dL (95% CI -3.16 to -1.21). HDL did not change [3]. Across 13 studies, LDL fell by 0.16 mmol/L (95% CI -0.22 to -0.09) [4].
Population: Adults in RCTs [3][4].
Sources: [3], [4]
Caveats: Both reviews pooled beverages with extracts.

Nordic dietStrong

LDL and total cholesterol

Shown to lower LDL cholesterol about 0.26 to 0.30 mmol/L against usual diets in adults with cardiometabolic risk factors.

Compared with control groups the source does not describe [1]; a usual or habitual Nordic diet, a usual Western diet or general healthy eating advice [2]; the participants' usual Western diet, in Swedish adults [3]; an average Nordic diet with the same calories [4]

The numbers and sources

Effect: In 5 RCTs (513 participants), a Nordic diet lowered total cholesterol by 0.38 mmol/L (95% CI -0.76 to -0.01) and LDL by 0.30 mmol/L (95% CI -0.54 to -0.06), with no change in HDL or triglycerides [1]. In 6 RCTs (717 participants), LDL fell 0.26 mmol/L (95% CI -0.52 to -0.00), with reductions in non-HDL cholesterol and apolipoprotein B [2]. In NORDIET, LDL fell 21% and HDL 5% over 6 weeks against usual diets [3]. In SYSDIET, non-HDL cholesterol fell 0.18 mmol/L (95% CI -0.35 to -0.01) against an average Nordic diet [4].
Population: Adults, mostly in Nordic countries, with raised cholesterol, metabolic syndrome or central obesity [1][2]; 88 Swedish adults with mild high cholesterol [3]; 200 adults with metabolic syndrome features [4].
Sources: [1], [2], [3], [4]
Caveats: Both meta-analyses pooled largely the same few trials. Heterogeneity was high (I² 89%) and certainty low for LDL in [2]. NORDIET lowered HDL along with LDL [3].

NutsStrong

LDL cholesterol and ApoB

Shown to lower LDL cholesterol by about 4.8 mg/dL per daily ounce of tree nuts, and by 10.2 mg/dL at about 67 g a day, along with ApoB.

Compared with control arms without nuts [4]; control diets the abstract does not describe [5]

HDL cholesterol, apolipoprotein A1 and blood pressure did not change significantly.

The numbers and sources

Effect: Per 1 oz (28.4 g) serving a day, tree nuts lowered total cholesterol by 4.7 mg/dL (95% CI 4.0 to 5.3), LDL cholesterol by 4.8 mg/dL (95% CI 4.2 to 5.5), ApoB by 3.7 mg/dL (95% CI 2.3 to 5.2) and triglycerides by 2.2 mg/dL (95% CI 0.5 to 3.8). HDL cholesterol, apolipoprotein A1 and blood pressure did not change significantly. Effects were stronger at 60 g a day or more and did not differ by nut type. ApoB fell more in people with type 2 diabetes (11.5 mg/dL) than in healthy people (2.5 mg/dL) [4]. Pooled individual data from 25 trials found a mean 67 g a day lowered total cholesterol by 10.9 mg/dL (5.1%) and LDL cholesterol by 10.2 mg/dL (7.4%). Triglycerides fell 20.6 mg/dL in people starting at 150 mg/dL or higher and not in others [5].
Population: 2,582 adults without cardiovascular disease in 61 trials of 3 to 26 weeks [4]. 583 adults with normal or high cholesterol not on lipid-lowering drugs, in 25 trials in 7 countries [5].
Sources: [4], [5]
Caveats: Trials were short and many are shared between the two analyses. Effects were largest in people with higher starting LDL cholesterol and lower body mass index [5].

TaurineStrong

Blood sugar and blood lipids

Shown to lower fasting glucose about 6 mg/dL and triglycerides about 14 to 18 mg/dL, mostly in people with obesity, diabetes or metabolic syndrome. HDL did not change.

HDL cholesterol did not change.

The numbers and sources

Effect: Fasting glucose fell by 5.9 mg/dL (95% CI -10.7 to -1.0) and triglycerides by 18.3 mg/dL (95% CI -25.6 to -11.0). HDL cholesterol did not change [4]. A second meta-analysis found fasting glucose 5.9 mg/dL lower, HbA1c 0.21% lower, triglycerides 14.4 mg/dL lower and LDL cholesterol 5.1 mg/dL lower [5].
Population: 25 RCTs, 1,024 participants [4]; 34 RCTs [5].
Sources: [4], [5]
Caveats: Most trials were short and enrolled people with obesity, diabetes or metabolic syndrome. Neither review measured hard outcomes such as heart attacks or diabetes onset.

TMGStrongHow often is not known

Higher cholesterol

Shown to raise total cholesterol, about 14 mg/dL in one review, at 4 g a day or more. Reviews differ on whether LDL rises.

LDL, HDL and triglycerides did not change significantly.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: At 4 g a day or more, betaine raised total cholesterol by 0.34 mmol/L (95% CI 0.02 to 0.65). LDL, HDL and triglycerides did not change significantly [7]. A second meta-analysis found total cholesterol 14.12 mg/dL higher (95% CI 9.23 to 19.02) and LDL 10.26 mg/dL higher (95% CI 6.14 to 14.38). Triglycerides, HDL, glucose, CRP, liver enzymes and blood pressure did not change [2].
Population: Adults in 6 RCTs from 2002 to 2018 [7]; RCTs pooled up to February 2021 [2].
Sources: [7], [2]
Caveats: The reviews differ on LDL. Subgroup analysis suggested the rise appears at 4 g a day or more [2]. In uncontrolled liver pilot trials at 2 to 8 g a day, LDL did not change and HDL rose at 2 and 4 g [6].

Vegan dietStrong

LDL cholesterol

Shown to lower LDL cholesterol about 0.24 to 0.30 mmol/L against omnivorous or control diets in adults.

Compared with the participants' habitual diet, unchanged, in 3 trials in US and New Zealand adults, and in 8 trials a National Cholesterol Education Program diet, American Diabetes Association and Korean Diabetes Association diets, a portion-controlled diet, a Mediterranean diet, a low-fat diet, a healthy omnivorous diet or a high-carbohydrate lacto-ovo vegetarian diet [1]; an omnivorous diet [3]

The numbers and sources

Effect: Vegan diets lowered total cholesterol by 0.30 mmol/L and LDL by 0.24 mmol/L (95% CI -0.40 to -0.07), with no change in HDL or triglycerides [1]. In 30 RCTs of vegetarian or vegan diets, LDL fell 0.30 mmol/L (95% CI -0.40 to -0.19) and apolipoprotein B 12.92 mg/dL, with similar effects across intervention diet types [3].
Population: Adults with overweight or type 2 diabetes [1]; adults in 30 RCTs [3].
Sources: [1], [3]
Caveats: The larger review pooled vegan and vegetarian diets [3].

Whole grainsStrong

LDL cholesterol

Shown to lower LDL cholesterol slightly, by 0.09 mmol/L, against refined-grain control foods in pooled trials, with whole-grain oats lowering cholesterol most.

Compared with non-whole-grain control foods [8]; refined grains or placebo [9]

The numbers and sources

Effect: Whole grain intake lowered LDL cholesterol by 0.09 mmol/L (about 3.5 mg/dL, 95% CI -0.15 to -0.03) and total cholesterol by 0.12 mmol/L (95% CI -0.19 to -0.05), with no effect on HDL cholesterol. Triglycerides tended to fall (-0.04 mmol/L, 95% CI -0.08 to 0.01). Oats had the largest effect on total cholesterol (-0.17 mmol/L) [8]. In a second review, whole-grain oats improved total cholesterol (SMD -0.54, 95% CI -0.95 to -0.12) and LDL cholesterol (SMD -0.57, 95% CI -0.84 to -0.31), and whole-grain rice improved triglycerides [9].
Population: 24 randomized trials in apparently healthy adults [8]. 25 randomized trials of 2 to 16 weeks in adults with or without cardiovascular risk factors [9].
Sources: [8], [9]
Caveats: Small changes over weeks. The second review found the LDL effect for oats, not for all whole grains combined [9]. Beta-glucan from oats is on its own page.

5:2 dietModerate

Weight loss compared with no diet or brief advice

Shown to lower body weight against control diets in adults with overweight or obesity. As one-off self-help instructions, it matched standard brief advice at one year.

Compared with a daily energy-restricted diet or a routine diet [7]; standard brief weight-management advice [8]

Visceral fat, total cholesterol, triglycerides, HDL, diastolic pressure, fasting glucose and HbA1c did not differ.

The numbers and sources

Effect: In 20 articles with 1,393 participants, 5:2 lowered body weight, BMI, waist circumference, body fat percentage, fat mass, fat-free mass, LDL cholesterol, systolic blood pressure and HOMA-IR against control groups. Visceral fat, total cholesterol, triglycerides, HDL, diastolic pressure, fasting glucose and HbA1c did not differ [7]. One-off 5:2 self-help instructions lost 1.9 kg at one year against 1.8 kg with standard brief advice (p 0.79), and 18% against 15% lost at least 5% of body weight [8].
Population: Adults with overweight or obesity in 20 trials [7]; 300 UK adults with obesity followed for one year [8].
Sources: [7], [8]
Caveats: The meta-analysis abstract reports significance without effect sizes [7]. Adherence to self-help 5:2 fell over the year [8].

Beta-sitosterolModerate

Blood pressure and other heart risk markers

Shown to lower systolic blood pressure by about 1.6 mmHg for plant sterols and stanols as a class. HDL, blood sugar and weight did not change.

HDL cholesterol, fasting glucose, HbA1c, body weight, waist and fat mass did not change.

The numbers and sources

Effect: Plant sterols and stanols lowered systolic blood pressure by 1.55 mmHg (95% CI 0.42 to 2.67), diastolic by 0.84 mmHg, apoB by 0.06 g/L and hs-CRP by 0.25 mg/L. HDL cholesterol, fasting glucose, HbA1c, body weight, waist and fat mass did not change [5].
Population: Adults of mixed health status in trials pooled across 14 meta-analyses. Blood pressure came from one of them [5].
Sources: [5]
Caveats: Class-level evidence, not beta-sitosterol alone. These are risk markers, not heart attacks or strokes. Certainty was moderate to high for most outcomes, downgraded for inconsistency, imprecision or publication bias [5].

DASH dietModerate

LDL and total cholesterol

Shown to lower LDL cholesterol slightly in adults, by 0.10 mmol/L across trials and 0.28 mmol/L in the original feeding trial.

Compared with control diets the source does not describe [3]; the DASH trial's control diet [6]; usual, low-fat and low-antioxidant diets, behavioral programs alone and usual gestational diabetes care [7]

An umbrella review reported the same pooled figures as, with no effect on HDL or triglycerides.

The numbers and sources

Effect: Across 20 trials, DASH lowered total cholesterol by 0.20 mmol/L (95% CI -0.31 to -0.10) and LDL by 0.10 mmol/L (95% CI -0.20 to -0.01) [3]. In the 8-week DASH feeding trial, total cholesterol fell 0.35 mmol/L (13.7 mg/dL) and LDL 0.28 mmol/L (10.7 mg/dL) against control, with no triglyceride change. LDL fell 11.2 mg/dL more in men than in women [6]. An umbrella review reported the same pooled figures as [3], with no effect on HDL or triglycerides [7].
Population: Adults in 20 trials of 2 to 24 weeks [3]; 436 adults with total cholesterol of 6.7 mmol/L or less, mean age 44.6, 60% African American [6].
Sources: [3], [6], [7]
Caveats: The umbrella review drew its lipid figures from the same meta-analysis, so the two are not independent [3][7]. The umbrella review rated most secondary outcomes very low to moderate certainty [7].

Fish oilModerate

LDL and HDL cholesterol

Mixed results: most reviews found little or no change in LDL or HDL, while subgroups saw LDL fall in some groups and rise in others.

Across mixed populations, HDL rose 1.55 mg/dL (95% CI 0.69 to 2.42), and LDL fell only in subgroups of women and of people with polycystic ovary syndrome.

The numbers and sources

Effect: The Cochrane review found little or no effect on blood lipids other than triglycerides [1]. In coronary heart disease, LDL and HDL did not change significantly, and total cholesterol fell slightly (SMD -0.12) [2]. Across mixed populations, HDL rose 1.55 mg/dL (95% CI 0.69 to 2.42), and LDL fell only in subgroups of women and of people with polycystic ovary syndrome [3]. In metabolic syndrome trials, LDL rose in low-dose subgroups (7.04 mg/dL short term, 35.5 mg/dL long term) [5].
Population: Trial participants in the four reviews above [1][2][3][5].
Sources: [1], [2], [3], [5]
Caveats: The reviews differ on direction in subgroups. The LDL rise in [5] came from few studies per subgroup.

Green teaModerate

Cholesterol

Shown to lower total cholesterol by 2.8 mg/dL in trials of catechin-enriched green tea drinks. LDL, HDL and triglycerides did not change significantly in those trials.

Compared with water or other placebo drinks, no intervention, or green tea drinks low in catechins [4]

LDL changed by -2.61 mg/dL (95% CI -5.49 to 0.27), HDL by -0.84 mg/dL and triglycerides by -0.77 mg/dL, none significant.

The numbers and sources

Effect: In the 9 trials that gave green tea as a drink, total cholesterol fell by 2.80 mg/dL (95% CI 0.16 to 5.43). LDL changed by -2.61 mg/dL (95% CI -5.49 to 0.27), HDL by -0.84 mg/dL and triglycerides by -0.77 mg/dL, none significant. Across all 31 trials of drinks and capsules, LDL fell by 4.55 mg/dL (95% CI 2.80 to 6.31) [4].
Population: 3,321 participants in 31 randomized trials, 9 of them using a green tea drink [4].
Sources: [4]
Caveats: The drinks in these trials were green tea beverages made with extract, carrying 400 to 928 mg of catechins a day, not ordinary brewed tea. Meta-regression found no significant difference between drinks and capsules [4]. Capsule trials are on the green tea extract page.

High-protein dietModerate

Blood pressure and triglycerides

Mixed results: triglycerides fell more on higher-protein diets in two meta-analyses, while blood pressure fell slightly in one and did not differ in another.

Compared with diets with less protein

In energy-restricted trials, triglycerides fell 0.23 mmol/L more (95% CI 0.12 to 0.33), and blood pressure and total, LDL and HDL cholesterol did not differ.

The numbers and sources

Effect: Across 74 trials, higher-protein diets lowered systolic (SMD -0.21, 95% CI -0.32 to -0.09) and diastolic blood pressure (SMD -0.18, 95% CI -0.29 to -0.06) and triglycerides (SMD -0.51, 95% CI -0.78 to -0.24). Total and LDL cholesterol, C-reactive protein and HbA1c did not change [6]. In energy-restricted trials, triglycerides fell 0.23 mmol/L more (95% CI 0.12 to 0.33), and blood pressure and total, LDL and HDL cholesterol did not differ [1].
Population: Adults in 74 trials [6] and in 24 weight-loss trials [1].
Sources: [1], [6]
Caveats: Restricting to studies at lower risk of bias reduced the triglyceride effect [6]. In type 2 diabetes, blood pressure changes were not significant [8].

Mediterranean dietModerate

Blood pressure, cholesterol and blood sugar markers

Shown to lower blood pressure about 3/2 mmHg and LDL cholesterol and HbA1c slightly in adults, at low to moderate certainty.

Compared with no or minimal intervention, and another dietary intervention the abstract does not name [2]; a low-fat diet, a low-carbohydrate diet and the American Diabetes Association diet [7]; control diets the source does not describe [10]

The numbers and sources

Effect: Against no or minimal intervention, systolic blood pressure fell 2.99 mmHg (95% CI -3.45 to -2.53) and diastolic 2.0 mmHg (95% CI -2.29 to -1.71) at moderate quality, with little or no effect on LDL or HDL. Against other diets, LDL fell 0.15 mmol/L (95% CI -0.27 to -0.02) and triglycerides 0.09 mmol/L, with little or no effect on blood pressure [2]. In 9 RCTs (1,337 people at raised risk of diabetes or heart disease), HbA1c fell 0.18 points (95% CI -0.35 to -0.01), LDL 0.10 mmol/L and triglycerides 0.20 mmol/L. Fasting glucose, insulin, insulin resistance and HDL did not change [10]. Over 12 months or more, blood pressure and lipids changed about as much as on comparator diets [7].
Population: Healthy adults and adults at high cardiovascular risk [2]; adults at increased risk of type 2 diabetes and heart disease [10]; adults with overweight or obesity [7].
Sources: [2], [7], [10]
Caveats: The Cochrane review rated the lipid evidence low or very low quality for most comparisons [2]. The changes are small next to drug effects.

SaltModerateHow often is not known

Hormone and blood fat changes on low-sodium diets

Shown to raise renin, aldosterone, noradrenaline, total cholesterol and triglycerides slightly when sodium was cut sharply in trials. LDL and HDL cholesterol did not change significantly.

LDL cholesterol changed by 2.46 mg/dL (95% CI -1 to 5.9) and HDL by -0.3 mg/dL (95% CI -1.66 to 1.05).

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: During sodium reduction, renin rose 1.56 ng/mL/hour (82 trials), aldosterone 104 pg/mL (66 trials) and noradrenaline 62.3 pg/mL (35 trials). Total cholesterol rose 5.19 mg/dL (95% CI 2.1 to 8.3, 27 trials) and triglycerides 7.10 mg/dL (95% CI 3.1 to 11.1, 20 trials). LDL cholesterol changed by 2.46 mg/dL (95% CI -1 to 5.9) and HDL by -0.3 mg/dL (95% CI -1.66 to 1.05) [5].
Population: 917 participants for cholesterol, 712 for triglycerides and 2,904 for renin, in randomized trials of low against high sodium diets [5].
Sources: [5]
Caveats: Many trials were short and cut sodium further than guidelines ask. The review authors note these changes were more consistent than the blood pressure effect in people with normal blood pressure [5].

CuppingLimitedStudied in men

LDL cholesterol, wet cupping

One small trial found LDL cholesterol fell after wet cupping in 47 healthy young men, with no significant change in total cholesterol, HDL or triglycerides.

Compared with no treatment [12]

The numbers and sources

Effect: Over 3 weeks after one wet cupping session, LDL cholesterol and the LDL to HDL ratio fell in the treated group against untreated controls (p < 0.0001). Triglycerides did not change, and total cholesterol (7% lower) and HDL (3% higher) did not differ significantly [12].
Population: 47 healthy men aged 18 to 25 [12].
Sources: [12]
Caveats: One small trial in young men without high cholesterol, with no sham. Wet cupping removes blood, and the authors compare it with phlebotomy [12].

DASH dietLimitedHow often is not known

Lower HDL cholesterol

Mixed results: one feeding trial lowered HDL cholesterol 3.7 mg/dL, while pooled trials found no HDL change.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In the 8-week DASH feeding trial, HDL fell 0.09 mmol/L (3.7 mg/dL) against control, more in people with higher starting HDL [6]. Pooled trials found no effect on HDL [7].
Population: 436 adults [6]; adults in controlled trials [7].
Sources: [6], [7]
Caveats: The trial authors wrote that the effect of the HDL drop on heart risk needed further study [6].

Grape seed extractLimited

Cholesterol

Limited evidence: a 50-trial review found lower total and LDL cholesterol and triglycerides, while an earlier review found no effect on lipids.

HDL did not change.

The numbers and sources

Effect: Across 50 trials, grape seed extract lowered total cholesterol (WMD -6.03, 95% CI -9.71 to -2.35), LDL cholesterol (WMD -4.97) and triglycerides (WMD -6.55). HDL did not change [5]. An earlier meta-analysis of 9 RCTs found no significant effect on lipid levels [2].
Population: Adults in RCTs [5][2].
Sources: [5], [2]
Caveats: The two reviews disagree.

Type in your own result

How it compares with the reference method

Matched the reference method1

Moderate

Fasting against not fasting

Shown to change little after eating: HDL cholesterol was at most 0.1 mmol/L (4 mg/dL) lower than fasting, 3 to 5 hours after a meal.

The numbers and sources

Compared with: A fasting blood sample
Effect: In 33,391 Danish adults, HDL cholesterol was reduced for up to 3 to 5 hours after the last meal, with a maximum change from fasting of -0.1 mmol/L [21]. A joint European consensus statement concluded that HDL cholesterol is not affected by fasting status and uses the same flag value for both kinds of sample [6]. In 68 pooled cohorts, hazard ratios were at least as strong in participants who did not fast as in those who did [8].
Population: 33,391 adults aged 20 to 95 in the Copenhagen General Population Study [21].
Sources: [21], [6], [8]
Caveats: A cross-sectional comparison of people sampled at different times after eating, not the same people tested twice [21].

Mixed results2

Limited

Directly measured HDL cholesterol

Mixed results: one study found 6 of 8 direct HDL methods met US accuracy goals in people without disease, and none met them in people with disease.

The numbers and sources

Compared with: Ultracentrifugation reference measurement procedure
Effect: Bias of 8 direct HDL cholesterol methods ranged from -5.4% to 4.8% in people without disease and from -8.6% to 8.8% in people with disease. Total error ranged from -13.4% to 13.6% and from -19.8% to 36.3%. Six of 8 methods met the National Cholesterol Education Program total error goals in people without disease. All failed in people with disease, which the authors attribute to a lack of specificity toward abnormal lipoproteins [20].
Population: Sera from 37 people without disease and 138 with disease, mainly dyslipidemia and cardiovascular disease [20].
Sources: [20]
Caveats: Published in 2010 on one analyzer, so the methods may since have changed. Small sample [20].

Moderate

Variation from one test to the next

Mixed results: a review of 30 studies put within-person variation of HDL cholesterol at about 7%, against about 23% for triglycerides.

The numbers and sources

Compared with: Repeat measurements in the same person
Effect: Pooling 30 studies published from 1970 to 1992, the average within-person biological variation was 7.4% for HDL cholesterol, with estimates from different models ranging from 6.2% to 7.5%. It was 6.1% for total cholesterol, 9.5% for LDL cholesterol and 22.6% for triglycerides [22].
Population: 30 published studies of repeat lipid measurements [22].
Sources: [22]
Caveats: The review is from 1993, and its estimates varied with each study's assay and design. It states no threshold for agreement, so the result is given as numbers only [22].

What studies tie it to

Linked in research2

Strong

Coronary heart disease in cohort studies

Linked to less coronary heart disease at higher levels, about 22% less for each 15 mg/dL higher across 68 pooled cohorts.

The numbers and sources

Effect: In 68 prospective studies, coronary heart disease rates per 1,000 person-years were 6.4 in the bottom third and 2.4 in the top third of HDL cholesterol. The adjusted hazard ratio was 0.78 (95% CI 0.74 to 0.82) per 15 mg/dL higher HDL cholesterol [8]. A separate pooled observational analysis found an odds ratio for heart attack of 0.62 (95% CI 0.58 to 0.66) per standard deviation higher [9].
Population: 302,430 people without vascular disease in 68 prospective studies, mostly in Europe and North America [8].
Sources: [8], [9]
Caveats: Observational. Low HDL cholesterol travels with high triglycerides, obesity, smoking and type 2 diabetes, so an association does not show that HDL cholesterol itself is protective [2].

Limited

Death from any cause at very low and very high levels

Two Danish cohorts linked both low and extremely high HDL cholesterol to more deaths, with the lowest risk at 73 mg/dL in men and 93 mg/dL in women.

The numbers and sources

Effect: The association with death from any cause was U-shaped in both sexes. The level with the lowest risk was 73 mg/dL (95% CI 54 to 77) in men and 93 mg/dL (69 to 97) in women. Against the lowest-risk groups, adjusted hazard ratios were 1.36 (95% CI 1.09 to 1.70) for men at 97 to 115 mg/dL and 2.06 (1.44 to 2.95) at 116 mg/dL or above. For women they were 1.10 (0.83 to 1.46) at 116 to 134 mg/dL and 1.68 (1.09 to 2.58) at 135 mg/dL or above [18]. A European guideline states that above about 90 mg/dL there appears to be an increased risk of atherosclerotic cardiovascular disease [4].
Population: 52,268 men and 64,240 women in two Copenhagen population studies, 745,452 person-years, 10,678 deaths [18].
Sources: [18], [4]
Caveats: Observational, from two cohorts in one Danish city, and the authors state the findings need confirmation in other studies [18]. The study cannot show that very high HDL cholesterol itself shortens life.

Mixed results1

Moderate

Stroke

Mixed results: 68 pooled cohorts found no clear link with ischemic stroke, and a meta-analysis tied higher HDL cholesterol to slightly more bleeding in the brain.

The numbers and sources

Effect: The adjusted hazard ratio for ischemic stroke was 0.93 (95% CI 0.84 to 1.02) per 15 mg/dL higher HDL cholesterol [8]. In a meta-analysis of prospective studies, the relative risk of hemorrhagic stroke was 0.98 (95% CI 0.80 to 1.19) for high against low HDL cholesterol and 1.11 (0.99 to 1.25) per 1 mmol/L higher. For intracerebral hemorrhage the pooled relative risk was 1.17 (95% CI 1.02 to 1.35) [19].
Population: 302,430 people in 68 prospective studies, with 2,534 ischemic strokes [8]. 1,430,141 participants in 23 prospective studies, with 7,960 hemorrhagic strokes [19].
Sources: [8], [19]
Caveats: Observational. Most intervals include no association [8][19].

Checked, no link found2

Moderate

Heart attack in genetic studies

Not shown to protect against heart attack in genetic studies: gene variants that raise HDL cholesterol alone did not lower risk.

The numbers and sources

Effect: Carriers of a variant in the endothelial lipase gene had HDL cholesterol 0.14 mmol/L higher, with other risk factors similar. That difference predicted a 13% lower risk of heart attack (OR 0.87), and the observed odds ratio was 0.99 (95% CI 0.88 to 1.11). A one standard deviation rise in HDL cholesterol from a 14-variant genetic score was also not associated with heart attack (OR 0.93, 95% CI 0.68 to 1.26). The same method applied to LDL cholesterol gave an odds ratio of 2.13 (95% CI 1.69 to 2.69) per standard deviation, in line with the observational estimate [9].
Population: 20,913 heart attack cases and 95,407 controls in 20 studies for the single variant, and up to 12,482 cases and 41,331 controls for the genetic score [9].
Sources: [9]
Caveats: One Mendelian randomization study. Its authors concluded that some genetic mechanisms that raise HDL cholesterol do not seem to lower risk, which does not rule out a role for other properties of HDL particles [9].

Strong

Heart attack and death in trials of drugs that raised HDL cholesterol

Not shown to cut heart attacks or deaths when raised by drugs: pooled trials of niacin, fibrates and CETP inhibitors in 117,411 patients found no reduction on statins.

The numbers and sources

Effect: In a meta-analysis of 39 trials, no significant effect on death from any cause was seen for niacin (OR 1.03, 95% CI 0.92 to 1.15), fibrates (0.98, 0.89 to 1.08) or CETP inhibitors (1.16, 0.93 to 1.44). Niacin reduced non-fatal heart attack in trials run before statins (OR 0.69, 95% CI 0.56 to 0.85) and not in trials where statins were taken (0.96, 0.85 to 1.09) [10]. A meta-regression of 108 trials found no association between the change in HDL cholesterol a treatment produced and coronary events or deaths, once the change in LDL cholesterol was accounted for [11]. Among CETP inhibitors, torcetrapib raised HDL cholesterol 72.1% and increased cardiovascular events (HR 1.25, 95% CI 1.09 to 1.44) and death from any cause (HR 1.58, 95% CI 1.14 to 2.19) [12]. Dalcetrapib raised it 31 to 40% with no effect on events (HR 1.04, 95% CI 0.93 to 1.16) [13]. Evacetrapib raised it 133.2% and lowered LDL cholesterol 31.1% with no effect on events (HR 1.01, 95% CI 0.91 to 1.11) [14]. Anacetrapib raised it by 43 mg/dL, lowered non-HDL cholesterol by 17 mg/dL and reduced major coronary events (rate ratio 0.91, 95% CI 0.85 to 0.97) [15]. Adding niacin to a statin raised HDL cholesterol from 35 to 42 mg/dL in one trial (HR 1.02, 95% CI 0.87 to 1.21) and by 6 mg/dL in another (rate ratio 0.96, 95% CI 0.90 to 1.03), without fewer events in either [16][17].
Population: 117,411 patients in 39 trials [10]. 299,310 participants in 108 trials [11]. 15,067, 15,871, 12,092 and 30,449 patients at high cardiovascular risk in the four CETP inhibitor trials [12][13][14][15]. 3,414 and 25,673 patients with vascular disease in the two niacin trials [16][17].
Sources: [10], [11], [12], [13], [14], [15], [16], [17]
Caveats: A marker that tracks risk is not always one whose raising changes it. Torcetrapib also raised blood pressure, an effect its investigators considered off-target [12]. The one trial with fewer events also lowered non-HDL cholesterol [15]. Niacin with laropiprant increased serious adverse events [17].

Sources

US Food and Drug Administration. 21 CFR 862.1475, Lipoprotein test system. Electronic Code of Federal Regulations, with the FDA product classification entry for over-the-counter high density lipoprotein tests (product code NAQ). https://www.ecfr.gov/current/title-21/section-862.1475
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the 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). JAMA. 2001. https://doi.org/10.1001/jama.285.19.2486
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019. https://doi.org/10.1161/CIR.0000000000000625
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. European Heart Journal. 2020. https://doi.org/10.1093/eurheartj/ehz455
Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026. https://doi.org/10.1161/CIR.0000000000001423
Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points. A joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. European Heart Journal. 2016. https://doi.org/10.1093/eurheartj/ehw152
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report. Pediatrics. 2011. https://doi.org/10.1542/peds.2009-2107C
Emerging Risk Factors Collaboration. Major Lipids, Apolipoproteins, and Risk of Vascular Disease. JAMA. 2009. https://doi.org/10.1001/jama.2009.1619
Voight BF, Peloso GM, Orho-Melander M, et al. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. The Lancet. 2012. https://doi.org/10.1016/S0140-6736(12)60312-2
Keene D, Price C, Shun-Shin MJ, Francis DP. Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117 411 patients. BMJ. 2014. https://doi.org/10.1136/bmj.g4379
Briel M, Ferreira-Gonzalez I, You JJ, et al. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systematic review and meta-regression analysis. BMJ. 2009. https://doi.org/10.1136/bmj.b92
Barter PJ, Caulfield M, Eriksson M, et al. Effects of Torcetrapib in Patients at High Risk for Coronary Events. New England Journal of Medicine. 2007. https://doi.org/10.1056/NEJMoa0706628
Schwartz GG, Olsson AG, Abt M, et al. Effects of Dalcetrapib in Patients with a Recent Acute Coronary Syndrome. New England Journal of Medicine. 2012. https://doi.org/10.1056/NEJMoa1206797
Lincoff AM, Nicholls SJ, Riesmeyer JS, et al. Evacetrapib and Cardiovascular Outcomes in High-Risk Vascular Disease. New England Journal of Medicine. 2017. https://doi.org/10.1056/NEJMoa1609581
HPS3/TIMI55-REVEAL Collaborative Group. Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease. New England Journal of Medicine. 2017. https://doi.org/10.1056/NEJMoa1706444
AIM-HIGH Investigators. Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy. New England Journal of Medicine. 2011. https://doi.org/10.1056/NEJMoa1107579
HPS2-THRIVE Collaborative Group. Effects of Extended-Release Niacin with Laropiprant in High-Risk Patients. New England Journal of Medicine. 2014. https://doi.org/10.1056/NEJMoa1300955
Madsen CM, Varbo A, Nordestgaard BG. Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies. European Heart Journal. 2017. https://doi.org/10.1093/eurheartj/ehx163
Wang X, Dong Y, Qi X, Huang C, Hou L. Cholesterol Levels and Risk of Hemorrhagic Stroke: A Systematic Review and Meta-Analysis. Stroke. 2013. https://doi.org/10.1161/STROKEAHA.113.001326
Miller WG, Myers GL, Sakurabayashi I, et al. Seven Direct Methods for Measuring HDL and LDL Cholesterol Compared with Ultracentrifugation Reference Measurement Procedures. Clinical Chemistry. 2010. https://doi.org/10.1373/clinchem.2009.142810
Langsted A, Freiberg JJ, Nordestgaard BG. Fasting and Nonfasting Lipid Levels: Influence of Normal Food Intake on Lipids, Lipoproteins, Apolipoproteins, and Cardiovascular Risk Prediction. Circulation. 2008. https://doi.org/10.1161/CIRCULATIONAHA.108.804146
Smith SJ, Cooper GR, Myers GL, Sampson EJ. Biological variability in concentrations of serum lipids: sources of variation among results from published studies and composite predicted values. Clinical Chemistry. 1993. https://doi.org/10.1093/clinchem/39.6.1012

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