Heart-protective cholesterol levels -
Indeed, there are some reports of increased cardiovascular events and even increased mortality associated with very high levels of HDL. In addition, pharmaceutical intervention studies aimed at increasing HDL levels did not result in amelioration of cardiovascular outcomes.
Dyslipidaemia is recognised as one of the most important risk factors for atherosclerotic cardiovascular disease ASCVD. However, the protective role of HDL cholesterol HDL-C has been seriously challenged by the evidence from recent genetic, epidemiologic and clinical trials.
There is now overwhelming evidence from different types of clinical and genetic studies that higher LDL cholesterol LDL-C is a potent cause of ASCVD [1].
It seems that there is no lower threshold for LDL below which no further decline in ASCVD occurs. Of importance, such low levels have not been associated with increased adverse events.
Evidence from genetic trials also suggests that disorders of low LDL-C are associated with protection from coronary disease [4]. Moreover, Mendelian randomisation studies have shown that prolonged exposure to lower LDL-C beginning early in life is associated with a significant reduction in the risk of coronary heart disease in a log-linear fashion, and that this reduction is substantially greater than the current practice of lowering LDL-C beginning later in life [4].
Many observational studies have demonstrated that low levels of HDL-C are associated with an increased risk of coronary heart disease []. The Framingham Study was the first and most important epidemiologic trial showing a strong, graded, independent, inverse relationship between HDL-C and both cardiovascular disease and total mortality [5].
Besides, HDL seems to have anti-inflammatory [9], anti-oxidant [10], and antithrombotic properties [11] which may contribute to its atheroprotective effects.
On the other hand, recent data challenge whether HDL-C really protects against ASCVD. Mendelian randomisation studies have consistently shown that increased HDL-C levels caused by common variants in HDL-related genes are not necessarily associated with lower incidence of cardiovascular events [12,13].
Indeed, patients with certain mutations in CETP, ABCA1, LIPC, and SCARB1 were found to have paradoxically increased risk of coronary heart disease despite having very high concentrations of HDL-C [14,15].
This is in contrast to the Mendelian randomisation studies suggesting a strong association between LDL-C and increases in ASCVD [4]. Large-scale prospective cohort studies also contradict the previous finding of a linear inverse relationship between HDL and cardiovascular disease [7,].
Although it is a common finding that low levels of HDL predict increased cardiovascular risk, data from several cohorts have revealed a plateau in the inverse association above certain HDL levels. There is even a suggestion of increased cardiovascular outcomes in those with extremely high HDLs.
Recently, Madsen et al [17] examined the association of significantly elevated serum HDL-C concentrations with outcomes in two large population-based cohorts from Denmark 52, men and 64, women. A similar conclusion has been reached by Bowe et al [18], who evaluated the relationship between HDL-C and risk of death in a study involving 1.
They found that HDL-C and risk of mortality exhibited a U-shaped association where risk of death is increased at low and high HDL-C levels. Figure 1. HDL cholesterol and risk of all-cause mortality in the general population.
Adapted with the permission of Oxford University Press on behalf of the European Society of Cardiology from Madsen MC et al.
Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies.
Eur Heart J. The aforementioned data suggest that the old and the new observational studies yield different results regarding the cardiovascular effects of high HDL-C.
At this point, it is important to highlight that the sample size of individuals with very high HDL-C i. Furthermore, as mentioned by Madsen et al [17], in many of these studies individuals were categorised into larger groups, such as quintiles, and the focus was on low concentrations of HDL-C, thereby failing to elucidate associations at higher concentrations.
A similar pattern of results against the protective effects of higher HDL was obtained in randomised intervention trials carried out with niacin, fibrates, and cholesteryl ester transfer protein inhibitors. Despite being efficient at increasing HDL values, none of them was able to reduce all-cause mortality or cardiovascular events [19].
Considered together, current data establish that higher HDL-C is not necessarily protective against cardiovascular disease and may even be harmful in extremely high values. On the other hand, it is not clear why very high levels of HDL-C could have negative effects while lower levels are predictive for increased cardiovascular risk.
It is conceivable that plasma HDL-C concentration may not be a reliable indicator of the vascular protective function of HDL, which is very complex. Extreme elevations in HDL may represent dysfunctional HDL in some individuals, which may promote rather than protect against cardiovascular disease.
Another possible explanation is that genetic mutations leading to very high HDL may also confer adverse vascular risk by unknown mechanisms. Although the bulk of new data suggests that higher HDL-C levels are not associated with better outcomes, it should be noted that the neutral or negative effects of very high HDL have yet to be proven.
Current guidelines recommend the use of total cardiovascular risk assessment tools as an important step in decision making for primary prevention of cardiovascular disease. HDL-C is one of the risk measures used in commonly utilised risk tools such as the Framingham Risk Score www.
The European Society of Cardiology also recommends measuring HDL-C to refine risk estimation further. We routinely use HeartScore, the electronic and interactive version of the European SCORE risk charts www.
The American Heart Association recommends a diet that contains a wide variety of fruits, vegetables, whole grains, nuts, beans, and lean proteins such as soy, poultry, and fish.
Your diet should be low in salt, sugar, saturated fats, trans fats, and red meat. Choosing healthy fats such as monounsaturated and polyunsaturated fats, like those found in olive oil and avocados, can help improve your HDL cholesterol. Omega-3 fatty acids also contribute to heart health.
Currently, the American Heart Association does not recommend drinking alcohol for heart health due to the risks related to high alcohol intake.
However, moderate alcohol intake — one drink or fewer per day for women and two drinks or fewer a day for men — may raise HDL cholesterol to a small degree.
Talk to your doctor about the potential of supplementing your cholesterol therapy with niacin , fibrates , or omega-3 fatty acids. A simple blood test can judge three important levels in your blood.
This is known as your lipid profile. Healthy cholesterol levels are associated with a lower risk of heart disease. Lowering the risk of heart disease is now the main focus for cholesterol treatment rather than achieving a particular number.
Some recommendations may include:. Overall, the best way to lead a heart-healthy lifestyle is to focus on changes that include steps toward healthy living. These recommendations include regular physical activity, heart healthy eating, and not smoking.
A lower HDL level is a sign that there is room for improvement when it comes to making heart-healthy choices. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.
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It can lower your chances of getting heart disease or having a stroke. All adults age 20 or older should have their cholesterol and other traditional risk factors checked every four to six years. If certain factors put you at high risk, or if you already have heart disease, your doctor may ask you to check it more often.
Work with your doctor to determine your risk for cardiovascular disease and stroke and create a plan to reduce your risk. Learn how to get your cholesterol tested. Your total cholesterol and HDL good cholesterol are among numerous factors your doctor can use to predict your lifetime or year risk for a heart attack or stroke.
Your doctor will also consider other risk factors, such as age, family history, smoking status, diabetes and high blood pressure. Lipid profile or lipid panel is a blood test that will give you results for your HDL good cholesterol, LDL bad cholesterol, triglycerides and total blood or serum cholesterol.
Watch an animation about cholesterol score. A healthy HDL-cholesterol level may protect against heart attack and stroke. Your doctor will evaluate your HDL and other cholesterol levels and other factors to assess your risk for heart attack or stroke.
People with high blood triglycerides usually also have lower levels of HDL. Genetic factors, Type 2 diabetes, smoking, being overweight and being sedentary can all lower HDL cholesterol.
Women tend to have higher levels of HDL cholesterol than men do, but this can change after menopause. Since LDL is the bad kind of cholesterol, a low LDL level is considered good for your heart health. LDL levels are one factor among many to consider when evaluating cardiovascular risk.
Talk to your doctor about your LDL cholesterol level as well as other factors that impact your cardiovascular health.
Y ou may not levdls every Heart-protective cholesterol levels value from Heart-protective cholesterol levels last physical, but you probably levelw one: Your cholesterol level. According Hezrt-protective the U. Why do Heart-protective cholesterol levels care so much about cholesterol? Jeffrey Berger, a cardiologist and director of the Center for the Prevention of Cardiovascular Disease at NYU Langone in New York City. Read on for the latest information from experts. The facts: Cholesterol, which is often described as a fat-like, waxy substance, is essential to the human body, including playing a key role during fetal development. Unlike low-density lipoprotein LDL cholesterol, the causality Heart-protective cholesterol levels high-density Body composition and performance goals HDL in the Hear-protective of atherosclerotic cardiovascular disease remains controversial. Cholestterol observational studies have Level a graded, inverse relationship between HDL cholesterol and both cardiovascular Heart-orotective and total mortality, so that higher HDL is better. However, recent large-scale cohort studies and Mendelian randomisation trials have failed to confirm that higher HDL levels are associated with improved outcomes. Indeed, there are some reports of increased cardiovascular events and even increased mortality associated with very high levels of HDL. In addition, pharmaceutical intervention studies aimed at increasing HDL levels did not result in amelioration of cardiovascular outcomes.
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