The Bad Side of “Good” Cholesterol
Josh Fischman:You go to the doctor for an annual checkup, right, Tanya?
Tanya Lewis:Sure. As any good health editor would!
Fischman: Me too. You get asked a bunch of personal questions, a coldstethoscopeon your skin, and the doctor draws some blood for standard lab tests. Among those tests, when you get them back, are two cholesterol numbers.
Lewis: Right. One is your level of low-density lipoprotein cholesterol, or LDL. It’s supposed to stay under 130 milligrams per deciliter—the lower the better.
The other one is high-density lipoprotein, or HDL. And that’s supposed to stay above 40 milligrams per deciliter. The higher it is, the better, we’re told.
Fischman: That’s because LDL is the “bad” cholesterol, the one that leads toartery-cloggingplaques, heart disease, strokes, and other nasty stuff. We want less of it.
HDL, on the other hand, is “good” cholesterol. We want more of it.
Lewis: HDL has this good reputation because it binds to LDL, carrying that bad stuff to the liver. From there it gets flushed out of your body, where it can’t hurt you.
Fischman: But … you know that old saying about having too much of a good thing? It seems to be true of good cholesterol.
Lewis: So, is it possible to have too much HDL?
Fischman: It is totally possible. Turns out that too much HDL actuallyraisesthe chances of artery and heart disease, the very things we’re trying to avoid.
Once you get above 80 for men and 100 for women—and I’m going to stop saying milligrams per deciliter because it’s a mouthful—you’re in the danger zone. A bunch of recent studies have found this effect.
But generally, that’snotwhat doctors have told patients.
Quyyumi:The teaching has been up until recently, that the higher the HDL, the lower the risk. So traditionally, physicians have been using very high HDL levels as a marker of a really healthy cholesterol profile.
Fischman: That’s the researcher behind some of the newer studies.
Quyyumi: My name is Arshed Quyyumi. I’m professor of medicine in the Division of Cardiology at Emory University School of Medicine in Atlanta, Georgia.
Fischman: He did a study ofmore than 400,000 people in the U.K., people without otherpredisposingrisk factors for heart disease. For men, cardiac and other disease risks went up if their HDL levels were under 40—or over 80. For women, the risk climbed once HDL levels topped 100.
Lewis: When you say “climbed,” how much of a risk are we talking about? A few small percentage points, or a much bigger increase?
Fischman: Excellent question, and I asked Quyyumiabout the amount of extra risk that people faced.
Quyummi: If you just took them…[full transcript]
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论文信息
Liu, C. et al. (2022) “Very high high-density lipoprotein cholesterol levels and cardiovascular mortality,” The American Journal of Cardiology, 167, pp. 43–53.
DOI:10.1016/j.amjcard.2021.11.041
Trimarco, V. et al. (2022) “High HDL (high-density lipoprotein) cholesterol increases cardiovascular risk in hypertensive patients,” Hypertension, 79(10), pp. 2355–2363.
DOI:10.1161/hypertensionaha.122.19912
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