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.

LDL More Than 160 Tied to Increased Mortality in Low-Risk Patients

Patients deemed at low-risk for cardiovascular disease (CVD) but with LDL levels above 160 face increased mortality risks over the long term, a Circulation study suggests.

Over 36,000 adults in Texas (median age, 42) with an estimated 10-year risk for atherosclerotic CVD events below 7.5% had their lipid levels measured and were followed for a median of 27 years. During that time, nearly 1100 CVD deaths and 600 coronary heart disease (CHD) deaths occurred.

After multivariable adjustment, participants with LDL levels of 160–189 mg dL had a 70% increased risk for CVD mortality and more than twice the risk for CHD mortality, relative to those with LDL below 100 mg dL. Increasing levels of non-HDL cholesterol were also associated with higher mortality risks.

The researchers note that 2013 cholesterol guidelines recommend statins for low-risk patients when LDL reaches 190 mg dL, with a class IIb recommendation for considering treatment at 160 mg dL. They say their current findings "suggest a stronger consideration of using the LDL-C greater than 160 mg dL cutoff."

My Take:
The medical norms for LDL are less than 130 mg dl. However, many labs list the medical norm as less than 100 mg dl as that is the goal of statin drug therapy. Many physicians like to drive the LDL level less than 60 mg dl, although the research indicates no additional benefit in cardiovascular risk is associated with this goal.

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.

New Recommendations for Statin Therapy

Harvard professors claim the new online cholesterol calculator is flawed and overstates a person’s risk of heart disease.
Monday, November 18, 2013

The new guidelines were developed by the American Heart Association (AHA) and the American College of Cardiology (ACC).

Under the new guidelines, people will be advised to take statins based on a number of different health risk factors. These risk factors include if they already have heart disease, if their LDL cholesterol is extremely high (180mg/dl) or if they’re middle aged with type 2 diabetes.

In addition, people between 40 and 75 years of age with an estimated 10-year risk of heart disease of 7.5% or more are advised to take a statin. Experts say this new rule could greatly increase the number of patients who will now be advised to take these drugs.

MY TAKE:
Forty-nine percent of Americans over the age of 60 currently take statin drugs. Statins are the most commonly written prescription in the United States. Statistically, statin drugs reduce the risk of sudden heart attack by one third. That seems like pretty compelling evidence to support statin use. However, the risk of sudden heart attack is only three percent and statin drugs reduce it all the way down to two percent. That’s a whopping decrease of one percent! Furthermore, more than half the population’s suffering their first heart attack have normal or even low cholesterol. The ACC has countered that statistic by suggesting that statin drugs should be added to our drinking water so everyone will be treated.

Statin drugs work (when they work) because they reduce inflammation, not because they lower total cholesterol and LDL cholesterol. In fact, the disruption of cholesterol metabolism by statin drugs causes cardiac myopathy (heart muscle disease) in ten percent of patients. Cholesterol is the raw material necessary for the body to create sex hormones, vitamin D, and a host of other complex chemicals needed for the body to function properly.

The most common cause of high cholesterol is an excess of saturated fat and trans-fats in the diet. Although the AHA and ACC both claim that dietary changes are the cornerstone of treatment, little or no attention to diet occurs in practice. The second major cause is an underactive thyroid. Synthroid (synthetic thyroid hormone) is the second most commonly prescribed medication in the United States. It is estimated that at least one third of cases of hypothyroidism are autoimmune in nature. Clinically, I estimate that number is closer to half of all cases. Although Synthroid alleviates some symptoms, it does not treat the underlying cause or reduce the cardiac risk associated with hypothyroidism.

The number three cause of high cholesterol is an imbalance in the flora of the digestive tract. Unhealthy bacteria can produce an estrogen analog, a chemical that resembles estrogen. The body absorbs this estrogen look-a-like and it stimulates cholesterol production. Overproduction of cholesterol from genetic flaws is the forth most common cause of high cholesterol. This can be determined by a simple blood test, the L(p)a. Elevation of the L(p)a is the only lipid blood test that does correlate with an increased risk of heart disease. The test is seldom run before placing a patient on statin drugs. Despite being genetically controlled, both niacin and gingko leaf extract have been shown to be very effective in reducing the L(p)a in several studies.

THE BOTTOM LINE:
Talk to your doctor about truly implementing a serious program of diet and exercise before resorting to statin drugs. You must be an active participant in your health care. Have through laboratory testing to include a thyroid profile, glycohemoglobin A1c, fibrinogen, homocysteine, and CRP (high sensitivity C reactive protein) in addition to the serum lipids. If you and your physician still decide you need to take a statin, add Co Q 10 to your supplements to offset some of the side effects of this drug.