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Dr. Keith Roach
To Your Good Health
Dear Dr. Roach: I'm a healthy and fairly active 62-year-old female. My blood pressure and cholesterol levels have always been very good, and there's no history of heart issues in my immediate family. At my last checkup, my total cholesterol was 178 mg/dL; my LDL was 81 mg/dL; my triglycerides were 61 (all a bit high for me); and my HDL was 87 mg/dL.
When reviewing these numbers, I noticed that some research suggests that an HDL over 80mg/dL is too high and can possibly lead to heart or stroke issues down the road. Can you comment on what is "too high" of an HDL? -- E.P.
Answer: Low levels of HDL cholesterol are known to be associated with a higher risk for heart attacks, while high levels of HDL are generally protective. However, there are a few exceptions to this rule:
In some people with a strong family of heart disease and high HDL cholesterol levels, the HDL particles were found to be different from normal HDL particles and weren't protective against inflammation in a cell culture. For this reason, I look at family history as a very important risk factor, which is not taken into account by most of the scoring systems that allow doctors to estimate heart disease risk. (Interestingly, the use of a statin drug helped the abnormal HDL particles work more effectively.)
Diabetics who are on insulin often have high HDL levels, which cannot be considered protective. There is also an unusual type of HDL particle found in an Italian village called ApoA-1 Milano that is highly protective against heart disease, even with low HDL levels.
I suspect that in the future, we will be looking at function (instead of just levels of cholesterol types and related proteins) to predict heart disease and determine who would benefit from medication. For right now, a scoring system such as PREVENT (tinyurl.com/PREVENTCalc), modified by family history, remains the best place for most people to start.
People with a strong family history and normal or low cholesterol levels should consider additional testing, such as Lp(a), a lipoprotein that predicts heart disease.