New research raises doubts about the link between ‘good’ cholesterol and heart disease
High-density lipoprotein cholesterol (HDL-C) is often called “the good cholesterol” due to the belief that low HDL-C levels indicate a person faces a higher risk of developing cardiovascular disease (CVD). According to a new analysis in the Journal of the American College of Cardiology, however, HDL-C levels may not be as effective at predicting CVD risk as scientists originally believed.[1]
“It’s been well accepted that low HDL-C levels are detrimental, regardless of race,” senior author Nathalie Pamir, PhD, an associate professor of medicine at Oregon Health & Science University, said in a prepared statement highlighting the new findings. “Our research tested those assumptions.”
Pamir et al. explored data from nearly 24,000 adults who participated in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. While 57.8% of patients were white, 58.4% were women. The mean patient age was 64 years old. All patients were free of coronary heart disease when the REGARDS study started, and each patient was followed for a median of 10 years.
Overall, during that follow-up period, 664 Black patients and 951 white patients experienced a heart attack or heart attack-related death. Looking at the HDL-C and low-density lipoprotein cholesterol (LDL-C) levels of each of these patients, the researchers determined that higher LDL-C levels were consistently associated with a higher risk of CVD. Low HDL-C levels, however, only accurately predicted a heightened CVD risk among white patients. HDL-C levels, it seems, may not be an accurate risk factor to focus on when it comes to Black patients.
“What I hope this type of research establishes is the need to revisit the risk-predicting algorithm for CVD,” Pamir said in the same statement. “It could mean that in the future we don’t get a pat on the back by our doctors for having higher HDL-C levels.”
The National Institute of Neurological Disorders and Stroke, National Institute of Aging and National Heart, Lung and Blood Institute (NHLBI) all helped fund this analysis. Sean Coady, a deputy branch chief of epidemiology within the NHLBI’s division of cardiovascular sciences, added his own perspective in the prepared statement.
“HDL-C has long been an enigmatic risk factor for CVD,” he said. “The findings suggest that a deeper dive into the epidemiology of lipid metabolism is warranted, especially in terms of how race may modify or mediate these relationships.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.