Study suggests HDL or “good” cholesterol is less beneficial than previously thought, especially for black adults


High-density lipoprotein, or HDL, cholesterol, often referred to as “good” cholesterol, may not be as helpful in predicting heart disease risk and protecting against it as previously thought, according to new research funded by the National Institutes of Health.

A study from the 1970s found that high levels of HDL cholesterol concentrations were associated with a low risk of coronary heart disease, a link that has since been widely accepted and used in heart disease risk assessments. However, only white Americans were included in that study.

Now, research published Monday in the Journal of the American College of Cardiology found that low HDL cholesterol levels were associated with increased risk of heart attack among white adults, but not among black adults. Furthermore, higher HDL cholesterol levels were not found to reduce the risk of cardiovascular disease in either group.

“It is well accepted that low HDL cholesterol levels are harmful, regardless of race. Our research tested those assumptions,” said Nathalie Pamir, lead study author and associate professor of medicine at the Knight Cardiovascular Institute at Oregon Health & Science University, Portland, in a news release. “It could mean that, in the future, our doctors won’t pat us on the back for having higher HDL cholesterol levels.”

The researchers used data from thousands of people who enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Participants were at least 45 years old when they enrolled in the program between 2003 and 2007, and their health was tracked for an average of 10 years.

The researchers found that high levels of low-density lipoprotein (LDL) cholesterol and triglycerides “modestly” predicted heart disease risk among black and white adults.

But they suggest that more work is needed to understand what drives racial differences in the link between HDL and heart disease risk.

And meanwhile, current clinical assessments of heart disease risk “may misclassify risk in black adults, which could hinder optimal cardiovascular disease prevention and control programs for this group,” they wrote.

CNN medical correspondent Dr. Tara Narula, associate director of the Lenox Hill Women’s Heart Program, said the study “highlights the very important need for more race- and ethnicity-specific research and that there is no one-size-fits-all approach.” “. . Furthermore, this research emphasizes the continued need for education that elevated HDL levels are not a free pass and that focus should be placed on managing elevated LDL and other known markers of increased cardiovascular risk. “

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