Let’s talk about cholesterol. It’s a waxy, pale yellow fat that moves through your bloodstream in tiny particles called lipoproteins, which are covered in protein and mix easily with blood. Cholesterol is essential for building cell membranes, making hormones, and synthesizing vitamin D. However, to avoid heart disease, it’s important to keep an eye on your blood cholesterol levels, especially your low-density lipoprotein (LDL), or “bad” cholesterol. Too much LDL can lead to artery-clogging plaque, increasing your risk of a heart attack.

Your cholesterol report, also known as a lipid profile or lipid panel, includes your high-density lipoprotein (HDL) levels too. HDL has been known as “good” cholesterol for a long time because studies have shown that people with high HDL levels are less likely to develop cardiovascular disease.

However, our understanding of HDL has changed over the years. Many cardiologists now think that HDL might just be a bystander rather than a protective factor against heart disease. Higher HDL levels are closely linked with healthy behaviors such as eating a healthy diet and getting regular exercise.

Rethinking HDL’s Role

Researchers have found that HDL’s function and role in the body are more complex than previously thought. HDL’s role was thought of as being a garbage truck. It would pick up extra cholesterol (garbage) from the bloodstream and arteries and take it to the liver to be recycled or disposed of.

This understanding led to the development of experimental drugs that dramatically increased HDL levels by 60% to 100%. Over the past decade, large clinical trials tested five of these drugs (known as CEPT inhibitors) in people with low HDL levels. But while the drugs reliably raised HDL levels, they didn’t achieve the most important goal: preventing heart attacks, strokes, and other complications from clogged arteries. Maybe, the thinking went, it wasn’t the number of garbage trucks that mattered but how good they were at picking up trash. That is, maybe the drugs increased the wrong kind of HDL cholesterol.

It turns out that HDL comes in different shapes and sizes. Some types are spherical, while others are doughnut-shaped. Some types of HDL are great at plucking excess cholesterol from LDL and artery walls (a process referred to as reverse cholesterol transport), while some are not.

A Better Garbage Truck?

What if you had an HDL-based drug specifically designed to improve reverse cholesterol transport? Think of it as an empty garbage truck with a better trash compactor. But when investigators tested four weekly infusions of this type of experimental drug on more than 18,200 recent heart attack survivors, it was no better than a placebo in preventing heart attack, stroke, or death, as detailed in a study published May 2, 2024, in The New England Journal of Medicine.

But these findings shouldn’t distract you from focusing on the factors you can control — namely, making sure your LDL is below 100 milligrams per deciliter, or even lower if you have heart disease. That’s true even if you have a high HDL level, which shouldn’t be considered overly reassuring or a reason to ignore an elevated LDL value.

HDL’s Evolving Role

Understanding the evolving role of HDL in heart health highlights the complexity of managing cardiovascular risk. While HDL levels are important, the quality of HDL and maintaining healthy behaviors like diet and exercise are crucial. Most importantly, focus on controlling your LDL levels to protect your heart. Stay informed, work with your healthcare provider, and continue making lifestyle choices that support your cardiovascular health. Your heart’s well-being is in your hands, and every positive step counts.

Dr. Bobish

Dr. Bobish and her team’s goal is to help you reduce your risk of heart disease. Helping you to understand your risk factors and make healthful lifestyle changes.

Remember regardless of age or current state of health it is never too late to start protecting your heart. It is also never too soon and the sooner you act the better. Follow us on Facebook to see our latest post helping to keep you heart healthy. You can also explore all our articles that offer diet and exercise tips, recipes and information on procedures and heart disease.

Dr. Bobish and her team focus on preventative care and are here to support you. Alpine Cardiology provides patients with education as well as compassionate care and treatment. We are committed to keeping you healthy and heart smart! Request an appointment at 989-448-7002