HDL ‘Good’ Cholesterol Isn’t Always Good for Heart Health

upstart writes:

The link between HDL and heart disease isn't clear-cut:

"Good" and "bad" cholesterol: These well-known characters have long starred in the saga of heart health. But in a major plot twist, "good" cholesterol, it turns out, is not always so good.

In the last dozen years or so, research on the particles that carry so-called good cholesterol - known as high-density lipoprotein, or HDL - has presented a much more nuanced and conflicted story about HDL's effect on cardiovascular disease.

And a new, large study brings fresh doubt. High levels of HDL cholesterol were not associated with protection against heart disease in Black or white participants, researchers reported in the November Journal of the American College of Cardiology. For low levels of HDL cholesterol, there was a split, with a link to higher risk of heart disease in white participants but not in Black participants.

The study is the first to find a difference in the risk tied to low levels of HDL cholesterol between Black and white people. It also adds to accumulating evidence that a high level of HDL cholesterol isn't necessarily helpful for one's heart health.

There appear to be other attributes of HDL that can be good. But researchers have also found that HDL's role in health is complicated and ever-changing, with plenty to figure out.

Cholesterol has long been explained as the "good" versus the "bad." A high level of the "good" kind has been tied to a lower risk of cardiovascular disease, while having lots of the "bad" kind - carried by low-density lipoprotein, or LDL, particles - has been linked to a higher risk.

[...] A person's HDL cholesterol level is just one part of the story, though. Commonly reported on blood tests, the level reflects the amount of cholesterol that HDL particles have on board. HDL carries cholesterol away from the arteries to the liver to be excreted. This helps keep cholesterol from building up in artery walls, which can eventually impede blood flow.

Recently, research on HDL has started looking beyond its cholesterol payload. "The big understanding over the last decade or so is that while you can measure the cholesterol, it doesn't really reflect the actual functions that HDL is doing in the body," says Anand Rohatgi, a cardiologist at the University of Texas Southwestern Medical Center in Dallas.

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