The latest research challenges the role of "good" cholesterol in predicting heart disease risk in general

A study supported by the National Institutes of Health found that HDL cholesterol, often referred to as "good cholesterol," may not be as effective at predicting cardiovascular disease risk in adults of different racial and ethnic backgrounds as
scientists once thought.

The study, published in the Journal of the American College of Cardiology, found that while low levels of HDL cholesterol predicted an increased risk of heart attack or related death in white adults, a long-accepted association, it was not true
for black adults.
In addition, higher HDL cholesterol levels were not
associated with a reduced risk of cardiovascular disease in both groups.

"Our goal is to understand this long-standing association that labeled HDL as good cholesterol and whether this is true for all races," said Dr.
Nathalie Pamir, senior author of the study and associate professor
of medicine at the Knight Cardiovascular Institute at Oregon Health and Science University in Portland.
"It is widely believed that low HDL cholesterol levels are harmful regardless of
race.
Our study validates these hypotheses
.
”

To do this, Pamir and her colleagues reviewed data from 23,901 U.
S.
adults who participated in the Causes of Stroke Geographic and Racial Disparities Study (REGARDS
).
Previous studies that shaped perceptions of "good" cholesterol levels and heart health were conducted in the '70s and were mostly white adult subjects
.
In the current study, the researchers were able to look at how cholesterol levels in middle-aged black and white people living across the country without heart disease overlapped with future cardiovascular events
.

Between 2003 and 2007, the researchers conducted relevant studies of participants in the study and analyzed information
collected over a period of 10 to 11 years.
Black and white study participants had similar characteristics, such as age, cholesterol levels and potential heart disease risk factors, including having diabetes, high blood pressure or smoking
.
During that period, 664 black adults and 951 white adults experienced heart attacks or heart attack-related deaths
.
Adults with elevated LDL cholesterol and triglyceride levels had a slightly increased risk of cardiovascular disease, consistent with
previous findings.

However, the study is the first to find that for white adults, lower HDL cholesterol levels only predict an increased
risk of cardiovascular disease.
It also expands on findings from other studies showing that HDL cholesterol levels are not always associated with
reduced cardiovascular events.
REGARDS' analysis, the largest study in the U.
S.
, showed that this applied to both black and white adults, suggesting that higher-than-optimal levels of "good" cholesterol may not have cardiovascular benefits
in either group.

"I hope that these kinds of studies establish the need
to revisit cardiovascular disease risk prediction algorithms," Pamir said.
"This could mean that, in the future, we won't get praise
from doctors for having high HDL cholesterol levels.
"

Pamir explained that when researchers study the role of HDL cholesterol in supporting heart health, they are exploring different theories
.
One is that quality is more important than quantity
.
That said, the functional quality of HDL—collecting and transporting excess cholesterol from the body—may be more important in supporting cardiovascular health than having more
HDL.

They also made microscopic observations of the properties of HDL cholesterol, including analyzing hundreds of proteins involved in cholesterol transport and how different associations based on one or group of proteins improve cardiovascular health prediction
.

Sean Coady, associate director of epidemiology in the Division of Cardiovascular Sciences at the National Heart, Lung, and Blood Institute (NHLBI), explains, "HDL cholesterol has long been a mysterious risk factor
for cardiovascular disease.
" "The findings suggest the need for more in-depth research on the epidemiology of lipid metabolism, particularly in how
ethnicity alters or mediates these relationships.
"

The authors conclude that, in addition to supporting ongoing and future studies exploring these links in diverse populations, the findings suggest that the use of HDL cholesterol by cardiovascular disease risk calculators may lead to inaccurate
predictions in black adults.

"When it comes to risk factors for heart disease, they can't be limited to one race or ethnicity
," Pamir said.
"They need to work for everyone
.
"

The REGARDS study was co-funded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging, with additional support
from NHLBI.

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