The role of “good” cholesterol in universal prediction of heart disease risk

A study supported by the U.S. National Institutes of Health has found that high-density lipoprotein (HDL) cholesterol, often called the “good cholesterol,” may not be as effective as scientists believed at consistently predicting cardiovascular disease risk among adults. of different . ..




A study supported by the US National Institutes of Health has found that high-density lipoprotein (HDL) cholesterol, often called the “good cholesterol,” may not be as effective as scientists believed at consistently predicting cardiovascular disease risk among adults. of different race and ethnic origins.

The research, published in the Journal of the American College of Cardiology, found that while low HDL cholesterol levels predicted an increased risk of heart attacks or related deaths in white adults, a long-accepted association, the same was not the case of adult blacks. Furthermore, higher levels of HDL cholesterol were not associated with a lower risk of cardiovascular disease in either group.

The goal was to understand this long-standing relationship that labels HDL as the beneficial cholesterol and whether that is true for all ethnicities. –explains the doctor Natalie Pamir, lead author of the study and associate professor of medicine at the Knight Cardiovascular Institute at Oregon Health & Science University. It is known that low levels of HDL cholesterol are harmful, regardless of race. Our research has challenged these hypotheses.“.

To do so, Pamir and his colleagues looked at data from 23,901 U.S. adults who participated in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.



The previous studies that modeled perceptions of “good” cholesterol levels and heart health were conducted in the 1970s using research with a majority of white adult participants. For the current study, the researchers were able to look at how the cholesterol levels of middle-aged black and white adults without heart disease living across the country correlated with future cardiovascular events.

Study participants enrolled in REGARDS between 2003 and 2007, and researchers analyzed data collected over a 10 to 11-year period. The black-and-white study participants shared similar characteristics, including age, cholesterol levels and underlying risk factors for heart disease, such as diabetes, high blood pressure or smoking.

During this period, 664 black adults and 951 white adults suffered a heart attack or heart attack-related death. Adults with high levels of LDL cholesterol and triglycerides had a slightly increased risk of cardiovascular disease, consistent with previous research findings.

However, study was the first to find that low HDL cholesterol levels only predicted increased risk of cardiovascular disease for white adults. It also expands on the findings of other studies showing that high HDL cholesterol levels are not always associated with a reduction in cardiovascular events.

The REGARDS analysis was the largest study in the United States to show this to be true for both white and black adults, suggesting that higher-than-optimal amounts of “good” cholesterol may not provide cardiovascular benefits for either groups.

What I hope this type of research establishes is the need to revise the cardiovascular risk prediction algorithm. Pamir comments. It could mean that in the future we won’t get a pat on the back from our doctors for having higher HDL cholesterol levels.“.

Pamir explains that as researchers study the role of HDL cholesterol in supporting heart health, they are exploring different theories. One of them is that of quality over quantity. That is, instead of having more HDL, the quality of its function — collecting and transporting excess cholesterol out of the body — may be more important in promoting cardiovascular health.

They are also looking under the microscope at the properties of HDL cholesterol, including analyzing hundreds of proteins associated with cholesterol transport and how varying the associations, based on a protein or groups of proteins, can improve predictions of cardiovascular health.

HDL cholesterol has long been an enigmatic risk factor for cardiovascular disease. –to remember Sean Coad, deputy chief of epidemiology in the division of cardiovascular sciences at the National Heart, Lung, and Blood Institute (NHLBI)–. 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.“.

The authors conclude that, in addition to supporting current and future research with different populations to explore these connections, the findings suggest that cardiovascular disease risk calculators using HDL cholesterol could lead to inaccurate predictions for black adults.

When it comes to heart disease risk factors, they can’t be limited to just one race or ethnicity warns Pamir. must apply to everyone“.

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