HDL’s Role in Heart Risk May Vary by Population – New Findings

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Scientists at Oregon Health & Science University have identified findings that challenge the idea that very high levels of so-called “good” cholesterol necessarily lower cardiovascular risk. The research also suggests that very low levels of this cholesterol fraction may not carry the same danger for all populations. These conclusions appear in a report associated with the Journal of the American College of Cardiology [Citation: JACC study summary, 2024].

Low-density lipoprotein, commonly described as “bad” cholesterol, constitutes a large portion of the body’s cholesterol pool. Elevated LDL is linked to higher chances of heart disease and stroke. In contrast, high-density lipoprotein, or HDL, is known to help remove cholesterol from the bloodstream and ferry it to the liver for disposal.

Earlier thinking tied higher HDL levels to reduced cardiovascular risk, while very low HDL levels were linked with greater risk. The latest study questions that universal link and shows a more nuanced picture.

The investigation followed about 24,000 adults over roughly a decade. Across the study period, 664 Black participants and 951 White participants experienced heart attacks or died from heart attacks. The groups shared similar ages, cholesterol profiles, and major heart disease risk factors such as diabetes, hypertension, and smoking, so the researchers focused on cholesterol levels themselves to see if race affected outcomes.

Findings confirmed that high LDL and triglycerides predict a higher risk of cardiovascular events, aligning with established knowledge from prior research.

When HDL was examined, the results did not support the notion that higher HDL universally guards against heart attacks for all racial groups. In White participants, very low HDL was linked to a higher risk of heart attack, a pattern not observed in Black participants within the study. In other words, HDL’s protective signal seemed to vary by ethnicity, suggesting additional biological or lifestyle factors at play.

Researchers posited that HDL may possess differing properties or subtypes that influence its impact on heart health. This could explain why simply raising HDL levels does not always translate into a lower risk for all populations.

Clinical practice often uses HDL and LDL measurements, along with triglycerides, to estimate cardiovascular risk. While several calculators exist to synthesize these numbers, ethnicity is not always incorporated, which can affect how risk is interpreted for diverse patient groups [Clinical guidelines note varied risk across populations, 2024].

Overall, the study reinforces the role of LDL and triglycerides as important risk indicators while urging clinicians to interpret HDL results with nuance. It highlights the need for more precise tools that consider population-specific factors when assessing heart disease risk in North American patients [Attribution: JACC study context, 2024].

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