HDL: The "Good" Cholesterol

Cholesterol is a waxy, fat-like substance that's found in all the cells in your body. Your liver makes cholesterol, and it is also in some foods, such as meat and dairy products. Your body needs some cholesterol to work properly. But having too much cholesterol in your blood raises your risk of coronary artery disease.

There are two main types of cholesterol: HDL (good) cholesterol and LDL (bad) cholesterol:
HDL stands for high-density lipoproteins. It is called the "good" cholesterol because it carries cholesterol from other parts of your body back to your liver. Your liver then removes the cholesterol from your body. LDL stands for low-density lipoproteins. It is called the "bad" cholesterol because a high LDL level leads to a buildup of cholesterol in your arteries.

A blood test can measure your cholesterol levels, including HDL. When and how often you should get this test depends on your age, risk factors, and family history. With HDL cholesterol, higher numbers are better, because a high HDL level can lower your risk for coronary artery disease and stroke. How high your HDL should be depends on your age and sex:

Group Healthy HDL Level
Age 19 or younger More than 45mg/dl
Men age 20 or older More than 40mg/dl
Women age 20 or older More than 50mg/dl
If your HDL level is too low, lifestyle changes may help. These changes may also help prevent other diseases, and make you feel better overall: Eat a healthy diet, stay at a healthy weight, exercise, avoid cigarettes, and limit alcohol.

Some cholesterol medicines, including certain statins, can raise your HDL level, in addition to lowering your LDL level. Health care providers don't usually prescribe medicines only to raise HDL. But if you have a low HDL and high LDL level, you might need medicine.

Wisdom Wednesday: ‘Good’ Cholesterol Might Be Bad Too

HDL cholesterol may be known as the “good” kind, but a new study suggests high levels of it are not always a good thing for women after menopause.

The study, of nearly 1,400 postmenopausal women, found that those with higher HDL levels were more likely to show “plaques” in their carotid arteries. Those arteries supply blood to the brain, and plaque buildup there signals an increased risk of both stroke and heart disease.

“We used to think, the higher the better,” said Dr. Karol Watson, director of the Women’s Heart Health Program at the University of California at Los Angeles. “But we’ve been rethinking HDL in recent years.” Watson, who was not connected to the study said “everyone agrees” that low HDL – below 40 mg/dL – is bad. But studies have also found that very high HDL is liked to trouble, too. For example, a 2016 study of over 630,000 people found that women and men with very high HDL – above 90 mg/dL – were more likely to die (of noncardiovascular causes) during the study period than those whose HDL was in the middle of the pack.

HDL is known as the “good” cholesterol because it does positive things, including clearing fat from the arteries and ushering it to the liver to be removed. But, Watson said, research suggests that HDL function can go awry when its environment is not ideal – such as when a person is obese or has diabetes or other health conditions causing chronic inflammation in the blood vessels. “HDL seems to be like a chameleon, changing based on its surroundings,” Watson explained.

Wisdom Wednesday: What You Need to Know About Cholesterol

Cholesterol plays a vital role in your health, so it’s important to understand the different types of cholesterol and how to influence their levels, a heart specialist says.

‘Good cholesterol – high density lipoprotein (HDL) – recycles cholesterol and fat in the body,” said Dr. Alex Garton. He’s a noninvasive cardiologist from Pinnacle Health Cardiovascular Institute, based in central Pennsylvania.

“What we call bad cholesterol, low-density lipoprotein (LDL), is ‘bad’ because any leftover LDL is deposited into the blood vessels, increasing the risk of vascular disease. HDL can help prevent this by ‘recycling’ excess amounts of bad cholesterol,” Garton explained in an institute news release.

Total cholesterol can be deceiving, so it’s important to know the levels of both your bad cholesterol and good cholesterol.

LDL levels should generally be kept below 130 mg/dL of blood. But a level of 100 mg/dL is considered “optimal.” The U.S. National Heart, Lung, and Blood Institute says.

HDL levels should be above 40 mg/dL, the NHLBI says. And, levels above 60 mg/dL are even better.

But cholesterol levels are only part of the overall picture, Garton said.

“Smoking cigarettes, having high blood pressure or having a family history of early heart disease can also increase a patient’s cholesterol-related risks. These factors actually lower the LDL cholesterol number that signifies a patient is at risk for heart disease,” he said.

Wisdom Wednesday: Lipid Panel Continued

This week we continue with the HDL, LDL, and triglycerides:

The HDL or high density lipoprotein laboratory range is 40-90 mg/dL while the functional range is above 55 mg/dL. It is produced in the liver and the intestines. HDL is a protein carrier which moves fats from the peripheral tissues to the liver.

HDL is often labeled as “good cholesterol” and it has a strong relationship with coronary artery disease (CAD). Levels below 25 mg/dL double the risk of CAD. Between 26-35, the risk of CAD is 50% higher. The average risk is from 45-59 and levels above that impart below average risk of CAD.

Smoking, excess weight and lack of exercise all diminish HDL levels. Typically, for every 3 pounds of weight loss, the HDL will increase by 1 mg/dL. Of note, high-fat diets consistently improve HDL levels. However, caloric restriction has been shown to lower HDL levels by 2-12 mg/dL although levels will improve again once a normal diet is resumed.

Steroids, diuretics and beta blockers all reduce HDL levels. Low HDLs are commonly seen with liver congestion or a fatty liver, high carbohydrate intake, sedentary lifestyle or exogenous estrogen use.
The LDL or low density lipoprotein is a protein carrier that moves fats from the liver to peripheral tissues. Generally, 60-70% of the total cholesterol is made up of LDL. The laboratory range is 60-130 mg/dL while the functional range is below 120. Most labs calculate the LDL rather than actually measure the level based on the ratios of the other lipids.

LDL is often mislabeled as “bad cholesterol”. It increases as carbohydrates (not fats) increase in the diet. Metabolic syndrome, liver congestion, exogenous hormones, hypothyroidism, oxidative stress and cardiovascular disease are all associated with levels over 140 mg/dL.

Levels below 100 are associated with low vitamin D levels, steroid hormone imbalanaces, hyperthyroidism, severe liver disease, chronic anemia sedentary lifestyle and, of course statin drug therapy.