'Good' cholesterol might actually be bad

Published Thursday 24 August 2017

By Ana Sandoiu
26

A new study suggests that 'good' cholesterol, also known as high-density lipoprotein, may
increase the risk of premature death.
Traditionally, we have been told by physicians not to worry about "good" cholesterol, which
is scientifically known as high-density lipoprotein. New research, however, finds an alarming
association between high levels of this cholesterol type and excessive mortality.

A new study published in the European Heart Journal finds that "good" cholesterol, or high-
density lipoprotein (HDL) cholesterol, may raise the risk of premature death.

By and large, the medical community suggest that higher levels of the good kind of
cholesterol are desirable, as it may protect against heart disease and stroke. By contrast, it is
the "bad" cholesterol, or low-density lipoprotein (LDL), that blocks the arteries.

The new research challenges this belief - at least in part. As the authors note, this is the first
time that a study has drawn a connection between high HDL cholesterol levels and excessive
mortality in the general population.

The study was carried out by researchers from the University of Copenhagen in Denmark.
Prof. Brge Nordestgaard, of the university's Department of Clinical Medicine, is the
corresponding author of the study, and Christian M. Madsen, of the university's Department
of Clinical Biochemistry, is the paper's first author.

'Good' cholesterol raises mortality risk

Madsen and colleagues combined data from the Copenhagen City Heart Study, the
Copenhagen General Population Study, and the Danish Civil Registration System.

In total, they examined data on more than 116,000 people and clinically followed them for an
average period of 6 years, during which time more than 10,500 people died.

Blood tests for both types of cholesterol levels were taken non-fasting, and statistically, the
researchers adjusted for all known variables that are normally associated with all-cause
mortality. Such factors included age, body mass index (BMI), smoking - both current and
cumulative - alcohol consumption, physical activity, and diabetes.

Overall, 0.4 percent of the men and 0.3 percent of the women had extremely high levels of
HDL in their blood. Extreme levels were defined as equal to or higher than 3.0millimoles per
liter for men, and equal to or higher than 3.5 millimoles per liter for women.
The study found that men with extreme levels of HDL in their blood had a 106 percent
higher chance of dying prematurely than men with normal levels of this type of
cholesterol. Women with extremely high levels of HDL cholesterol were 68 percent
more likely to die prematurely than women with normal levels.

Additionally, the mortality rate in men with "very high" levels of the supposedly good kind of
cholesterol also had a 36 percent higher mortality rate than men with normal levels.

The lowest mortality rate was found in those with medium levels of HDL. This was defined
as 1.9 millimoles per liter for men and 2.4 millimoles per liter for women.

Prof. Nordestgaard spoke to Medical News Today about the significance of the findings,
saying, "Until now everybody has believed that the higher the HDL cholesterol the better."

"But we now show that individuals with extremely high HDL cholesterol have a higher
mortality rate than those with average levels. People and doctors should stop thinking that
HDL cholesterol is 'good' cholesterol and that it may be advantageous to raise HDL
cholesterol."

Prof. Brge Nordestgaard

"Rather," Prof. Nordestgaard continued, "they should focus on reducing LDL and remnant
cholesterol (=cholesterol in triglyceride-rich lipoproteins) with lifestyle changes or drugs."

He cautions that as the study was observational, it cannot explain causality. But he suggests
that future studies should try "to understand why people with the very highest HDL
cholesterol have increased mortality."