What's the deal with HDL?

July 15, 2019 11:42 AM

39 Female with a family history of heart disease. My HDL is over 100 - is this a good thing or a bad thing?

I had a full physical recently. Heart attacks run in my dad's side (South Asian), and not at all on my mother's side (Italian/Mediterranean). I exercise regularly and eat my vegetables and legumes, but also really love ice cream and chocolate. Trying to figure out if my numbers are good or not so great, but the internet tells me mixed things.

Total cholesterol: 253
HDL: 117
LDL: 120
Triglycerides: 72
CHOL/HDLC ratio: 2:2

Tri's are good. My LDL is slightly elevated. Some say that the higher your HDL, the better. Some say that over 100 can actually have adverse effects (https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/hdl-cholesterol/art-20046388). What does the latest science say about HDL and cholesterol in general? I don't think I'm imminently at risk, but how should I be thinking about my numbers? (also yes, YANMD)

posted by raztaj to Health & Fitness (8 answers total)

You should feel like you can go over these with your doctor. If your doctor isn't willing to tell you what your labs mean, find a new one.
posted by cakelite at 11:55 AM on July 15, 2019

Response by poster: To add, I did discuss my numbers with my doctor. They are of the "the higher the better" camp regarding HDL, but I understand there are mixed perspectives. I'm just trying to broaden my own understanding to take charge of my own health, since the verdict on high HDL appears to not be so definitive.
posted by raztaj at 12:01 PM on July 15, 2019 [3 favorites]

A HDL above 60 is associated with a lower risk of heart disease.

LDL cholesterol. The LDL measurement is usually considered the most important for assessing risk and deciding on treatment. The definition of a healthy level keeps on getting lower. For people at low risk of heart disease, an LDL of less than 100 is desirable, However, people at higher risk of heart disease, an LDL of less than 70 or perhaps even lower is considered "optimal."

LDL = Total cholesterol – HDL – (Triglycerides ÷ 5). LDL can also be measured directly in a non-fasting blood sample, but I found that formula helpful as it gives more idea of how the numbers influence each other.

According to my doctor the Ratio of CHOL/HDLC is one I should concentrate on watch as HDL basically cleans up the Cholesterol from your blood & takes it to your liver so keeping that ratio low (below 5) is good.

Having said that some doctors think tracking your non HDL levels is better. Simply subtract your HDL from your total cholesterol number. An optimal level of non-HDL cholesterol is less than 130 Higher numbers mean a higher risk of heart disease.

Looking at your figures they're almost identical to mine & my doctor advised me to change up my diet, eat more fibre to clean out the LDLs & eat more good fats & get my ass moving by getting some exercise in a few times a week, even just walking was fine by her.

Again IANYD or particularly smart I am someone with figures close to yours that asked some questions & did some reading & a smarter person than me might well come along & say I've understood it all wrong but hope it helps.
posted by wwax at 12:44 PM on July 15, 2019 [2 favorites]

Agree with cakelite that you should discuss your labs with your doctor. These numbers strike me as high, but given your age, probably not something to worry about -- but maybe something to spur you to find ways to bring them down. I did a deep dive into this a few months back and found, as you did, that while the thinking has previously been that the higher the HDL the better, some research shows that may not be so. This, for example. But I also came away feeling that nobody fully knows. Still, given your family history and your high-ish numbers, seems good to be proactive and talk to your doc about this.
posted by swheatie at 1:24 PM on July 15, 2019 [1 favorite]

The ultimate question is not what the numbers mean for risk, but what they mean for your behavior. As you note, recent research indicates uncertainty about what the unusually high LDL numbers mean. But as a relatively young, healthy woman, your risk of near-term heart disease is extremely low (per here). You don't seem to be a candidate for drug treatment, and you exercise and eat well. (Anyone who is even asking this question is probably eating better than 80 percent of the U.S. population.) So I think you're basically asking how risky it is in the long term to eat the amount of ice cream and chocolate you currently eat. I'm no expert, but given the uncertainty about the effects of high HDL and the uncertainty about the health effects of milk fat consumption, I doubt that even the most expert cardiologist could tell you with any real confidence.

So the question is how to act given that you don't know the risks. Personally, I'd keep up the exercise and vegetables and still enjoy the Ben and Jerry's on a semi-regular basis. After all, worrying too much will probably just give you a heart attack.
posted by Mr.Know-it-some at 2:05 PM on July 15, 2019 [1 favorite]

That's a good article linked by swheatie . It basically says that it's not known what the cause for the increased heart disease risk for people with very high HDL levels is and that:

the appropriate management [for people with very high HDL] is not known at this time. Patients with very high HDL cholesterol should continue to address other modifiable risk factors -- such as high blood pressure, smoking and obesity -- to reduce cardiovascular disease."

So in your case I would try to lower your LDL levels and make sure your blood pressure is not elevated. Diabetes increases heart disease risk and since South Asians (I'm one) are at an increased risk for diabetes, I would make sure your fasting blood glucose and Hemoglobin A1C are okay as well. I don't think you need to worry since it sounds like you have healthy habits already but you might want to ask your Doctor to go over your fasting blood glucose result, Hemoglobin A1C result, and blood pressure reading with you.
posted by mundo at 2:32 PM on July 15, 2019

HDL was thought to be protective based on the sort of "is x associated with y" type of study swheatie links to. But the sort of study that can more definitively answer "does x cause y" is a Mendelian randomization study. It's been known for some time that in fact genetic determinates of HDL levels are not causatively related to cardiovascular risk (see for example this study published in 2012 in Lancet ). Checking Pubmed there is Mendelian randomization data showing higher HDL levels are associated with an increased risk for macular degeneration and reduced risk for kidney disease. At 39 you are super young - too young to use the standard risk estimators to help guide treatment decisions - so a good time to focus on healthy lifestyle choices as you are doing.
posted by schmoft at 4:46 AM on July 16, 2019

I am not in food research, and I don't know the recent literature in that field, but I do have some qualms about the paper that Mr.know-it-some links. The authors use the word "narrow-minded" to describe other's nutritional research, which I'm surprised got through the review process. The authors have links to the animal agricultural industry and are funded by Enterprise Ireland, a business booster organization. The journal is run by a controversial organization MDPI. I don't know how typical this is in the field, but from an outside perspective, I would not use this article to make health choices.
posted by SandiBeech at 9:06 AM on July 17, 2019