New Theories on Lipid Levels - Is High HDL a Bad Actor?

A new study done by the Cardiology Department at Emory University in Atlanta has shown that

HDL levels above 80 mg/dL were actually associated with higher risk for both all-cause mortality

and also cardiovascular disease compared to individuals with levels between

40-60 mg/dL. A U shaped association was found with higher risk for both very low and very

high HDL levels. These results are contrary to the prevailing thought that the “higher the HDL

level, the better”. Many physicians will purposefully NOT treat a patient with significantly

elevated TOTAL and LDL cholesterol levels if the HDL level is high (over 75-85). There have been

no studies that have shown that this treatment hypothesis is actually beneficial, but the general

thinking is that every 1 point increase of the HDL level is associated with a 2% reduction in cardiac

events. This new study that was presented in the Journal of the American College of Cardiology

in May of 2022, totally debunks this widely held theory.

With the different ratios that many people use to “massage the numbers” so that they

do not need to intervene pharmacologically in treating elevated cholesterol levels (i.e., total

cholesterol/HDL levels below 5), it seems that this new information will also put a dent in

relying too heavily on this ratio. The one number that seems to have the most impact

on the development of coronary disease is the LDL level and it should be treated

aggressively.

New studies that reveal results that are totally at odds to what has been

thought of as dogma in any particular field should always be interpreted

cautiously and possibly even repeated to confirm these surprising findings.

Until that is done, relying on a very high HDL level as being totally “cardioprotective”

needs to be rethought as too high of a HDL level may be too much of a good thing.