Researchers take closer look at how effective good cholesterol is in preventing heart disease

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

A study from the 1970s found that high levels of HDL cholesterol concentration were associated with low coronary heart disease risk, 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 levels of HDL cholesterol were associated with higher risk of heart attack among white adults, but the same was not true among Black adults. Also, higher levels of HDL cholesterol were not found to reduce the risk of cardiovascular disease for either group.

“It’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions,” said Nathalie Pamir, a senior author of the study and an 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, we don’t get a pat on the back by our doctors for having higher HDL cholesterol levels.”

The researchers used data from thousands of people who were 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 analyzed over an average of 10 years.

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

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

And in the meantime, current clinical assessments for heart disease risk “may misclassify risk in Black adults, potentially hindering optimal cardiovascular disease prevention and management 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 ethnic-specific research and that there is not a one-size-fits-all approach. Additionally, this research emphasizes the continued need to educate that high levels of HDL are not a free pass and focus must be placed on controlling elevated LDL and other known markers of increased cardiovascular risk. “

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