The Truth About HDL Cholesterol

In your fight against the various weight and diet-related diseases and complications, you must have heard about high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterols. Every self-professed health nut with a stomach that cannot be pleased would have studied this topic vigorously in an effort to balance staying healthy and eating happily.

You would have also heard that HDL cholesterols are the so-called “good” cholesterol and that you should have more of it, while avoiding their evil counterparts, the LDL cholesterols, like the Plague. After all, HDL is like an artery scrubber that faithfully removes a build-up of fatty deposits or plaque along artery walls to ensure good traffic and reduce the risk of coronary heart diseases.

So eating lots of food with HDL should be a good thing, right?


What Is Cholesterol?

Found throughout the body in cells, cholesterol is a waxy and fat-like compound. Contrary to popular belief, your body actually needs cholesterol and uses it to produce hormones, vitamin D and other substances. However, the body produces all the cholesterol it needs, unlike certain essential nutrients that can only be derived from outside sources. Sources of externally-derived cholesterol can be found in foods such as meat, eggs and cheese.

If the cholesterol level in your blood is too high, it can inadvertently combine with other substances present in blood to form plaque that lines the walls of your arteries, a condition called atherosclerosis. Over time, the plaque can become so thick it restricts blood flow or blocks the artery entirely, an especially dangerous situation with the presence of blood clots.

HDL, or high-density lipoprotein, is referred to as the “good” cholesterol as it helps transport cholesterol from other areas of your body back to your liver for removal. LDL, or low-density lipoprotein, gets its deserved reputation as the “bad” cholesterol as it is responsible for the buildup of plaque along your artery linings.


Too Much Of A Good Thing Makes It Bad

Although having ample HDL cholesterol in the blood has been linked to lower risks of getting coronary heart disease and stroke, the wisdom of moderation still rings true.

Studies both large and small across various countries and people groups have shown that the chart depicting the relationship between HDL levels to heart disease and mortality rate forms a U-shaped curve — on average, too little HDL and too much of it are associated with a heightened risk of developing heart diseases, cancer and a premature death.

Although heart experts are still unsure why very high HDL levels become a health risk, the results of the studies reinforce the importance of not focusing on the “good” cholesterol but on more “bad” cholesterol; LDL is currently still too high in many people across the world and poses a public health risk.


Doctors Are Rethinking Cholesterol Treatment

The studies’ findings have caused doctors to relook into how patients at higher risk of developing heart attack, stroke and other cardiovascular problems should receive treatment.

President of the American College of Cardiology, Dr C. Michael Valentine regards that high cholesterol treatment should not be one-size-fits-all. New guidelines released together with the American Heart Association emphasise the importance of care that is personalised and not template-prescriptions based only on blood test results. They also express that considering traditional risk factors such as smoking, high blood pressure and high blood glucose is not enough in itself to determine the treatment options and methods.

Not all with high cholesterol need drug treatment. In actual fact, unless LDL levels tip the scales or the patient is currently suffering from heart disease, the treatment for cholesterol should not start with drugs but with a lifestyle alteration incorporating a diet good for the heart, physical exercise and effective weight loss. Only when this method fails should doctors consider drug treatment.


Get Screened

Cardiovascular disease, unlike diseases from bacteria or viruses that can happen suddenly, develops over the course of life, can begin at any stage of life and its symptoms can go unnoticed for a long time or simply has no symptoms at all until the final moment.

An elevated cholesterol level at any given age has a compounding effect that increases cardiac risk gradually. Therefore, you should not wait for an opportune time to think about heart disease, not that there is one, to begin with.


The Golden Question

So how much HDL and LDL is considered a healthy amount?

The answer: It depends on your family history as well as what else is happening in your body and what your lifestyle is like.

According to Dr Marc Allard-Ratick of Emory University School of Medicine in Atlanta who had spent considerable time studying the link between the risk of cardiovascular disease or dying from it and HDL cholesterol levels, 40-60mg per 100ml of blood serum is the “sweet spot, at the bottom of the U-shaped curve”, while a very low HDL level at less than 30mg is not a good sign, nor is a level beyond 70mg healthy either. Having too low or too high of an HDL level is an added risk for people with existing heart disease or increases the probability of developing one in people who otherwise do not.

On the other hand, there is no sweet spot for LDL and it poses risks at any level — the higher it is, the worse the outlook is for you. The current recommendation is to keep it below 100mg per 100ml of blood serum in healthy people and below 70mg for those who already have or are at high risk of heart disease.