HDL Cholesterol: Too Much of a Good Thing?

HDL Cholesterol: Too Much of a Good Thing?

An ample supply of HDL cholesterol in blood serum has long been linked to protection against coronary heart disease and stroke, so what could be bad?

A series of studies, large and small, in this country (USA) and abroad shows that the relationship of HDL levels to heart disease and overall mortality forms a U-shaped curve: too little and too much of this blood lipid are, on average, associated with an elevated risk of heart disease, cancer and premature death.

Although cardiologists can still only guess at why very high HDL levels may incur a health risk, the findings reinforce the importance of focusing less on the “good” cholesterol and even more on the “bad” — the level of LDL, or low-density lipoprotein, cholesterol that is still too high in as many as one-third of adults in this country.

These findings, among others, are prompting doctors to rethink their approach to patients who may have an elevated risk of developing a heart attack, stroke or other life-threatening cardiovascular problem.

The guidelines emphasize the importance of personalized care, not cookie-cutter prescriptions based solely on blood test results.

Since the last such guidelines were issued in 2013, Dr. Valentine said, “we’ve learned even more about new treatment options and which patients may benefit from them.” Experts have also learned that in most cases, it is not necessary for cholesterol tests to be done only after an overnight fast, which should be a relief for both patients and their doctors.

Everyone with high cholesterol may not need drug therapy to lower this harmful blood fat. In fact, unless LDL levels are astronomically high or the person has known heart disease, treatment should not begin with a drug but with lifestyle: a heart-healthy diet, physical exercise and, if needed, weight loss. If a doctor is still uncertain about which patients warrant a drug remedy to lower cholesterol, the new guidelines suggest getting a coronary artery calcium score, obtained via a specialized X-ray scan that measures calcium-containing plaque in the arteries that feed the heart.

More thinking is certainly good news as we firstly need more information about cholesterol and secondly not to just prescribe drugs as a knee-jerk reaction. There is a lot more information and guidance in the new guidelines so whilst I'm not a doctor and cannot give medical advice, I'd suggest you bring these guidelines to the attention of your doctor when discussing potential treatments.

See https://www.nytimes.com/2018/12/24/well/eat/hdl-cholesterol-too-much-of-a-good-thing.html. The new 2018 ACC/AHA Multisociety Guideline on the Management of Blood Cholesterol can be found online at https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/09/14/28/2018-guideline-on-management-of-blood-cholesterol.

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HDL Cholesterol: Too Much of a Good Thing?
As with many other good things in life, this usually helpful protein is best in moderation.

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