A new study suggests that too much "good" cholesterol can be just as bad as too little. Dr. Sanaz Majd joins Nutrition Diva to determine what this new research means for our heart health and risks.
A couple of weeks ago, I had a basic blood test for my routine physical. The numbers all looked pretty good, but my doctor and I were very excited about my HDL score, which was 88 mg / dL.
Just as a quick review, there are many different types of cholesterol in the blood, and HDL (which stands for high-density lipoprotein) is what we often call the “good” cholesterol. We don't want it to be too low because having an HDL level below 40 mg / dL puts us at higher risk for heart disease.
So, I was feeling pretty braggy to have an HDL level that was almost double that goal. But a couple of days later, a new study yielded some surprising findings.
Although low HDL levels are a risk factor for heart disease, this study found that very high HDL levels (like mine) may not be cause for celebration. In this study, those with HDL levels above 60 also had an increased risk of heart attack or death due to heart disease.
My first call was to my friend and physician, Dr. Sanaz Majd, to ask whether or not having high HDL levels is something we should be concerned about.
The highlights of our conversation are below:
Nutrition Diva: So Sanaz, how concerned should we be about high HDL levels?
Dr. Majd: Well Monica if you are in trouble then I am worse, my HDL is 108!
There are some other studies that suggest that very high HDL levels can increase your risk. And there are other studies that show otherwise! It's not enough to change our cholesterol practice at this point, but it's enough to start a conversation about this.
We need more research on how exactly to know if high HDL is "dysfunctional" HDL that could help us increase our risk of heart disease. The question really is: do all people with very high HDL have dysfunctional HDL? Or just a subset?
ND: Before continuing, can you help me understand what you mean by dysfunctional HDL? I have written in the past about how the size and shape of cholesterol particles can be a major factor in increasing or not increasing your risk. Is this a similar situation?
SM: Yes, exactly. It's just a hypothesis, but the theory is that even though there is more good cholesterol, the particles don't really work the way they're supposed to.
MR: Tell us what this latest study is about.
SM: The study investigated nearly 6,000 people with established heart disease and an average age of 63 years. They found that HDLs above 60 mg / dL had a nearly 50% higher risk of dying from a heart problem compared to those with levels between 41-60.
It doesn't really tell the rest of us that maybe we're younger and don't have heart disease. You wouldn't lose sleep even with high HDL levels if your other cholesterol levels are within target and you don't have heart disease or risk factors for heart disease.
MR: That is reassuring. Because the things that are associated with higher HDL levels are generally healthy habits. For example, when people try to increase low HDL levels, I suggest they lose weight if they need to, exercise, and eat more fiber. And I can't imagine anyone recommending that you gain weight, exercise less, and eat less fiber to lower your HDL!
But what about those who have high LDL cholesterol or heart disease or other risk factors? Should they be concerned about high HDL levels?
SM: At present, treatment guidelines are still primarily aimed at lowering LDL (which is bad cholesterol) and not worrying about HDL one way or another. We would need more data to change this practice guide at the clinical level. So while it's something to think about, it's not enough to change the way we treat heart disease or risk factors.
By Monica Reinagel, MS, LD / N, CNS, Nutrition Diva