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Very high HDL raises risk for MI, death
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MUNICH — In a new study, patients with HDL levels greater than 60 mg/dL had a nearly 50% increased risk for all-cause mortality, CV mortality and MI compared with HDL levels of 41 to 60 mg/dL.
These findings challenge the conventional wisdom that higher HDL levels are beneficial for CV health, Marc Allard-Ratick, MD, of Emory University School of Medicine, Atlanta, Georgia, said during a press conference at the European Society for Cardiology Congress.
“While we know that HDL cholesterol has been termed the ‘good’ cholesterol for many generations, it may be time to start thinking about it in a different way,” Allard-Ratick said. “Instead, it may be something that needs to be ‘just right’ — not too high, not too low.”
The study included 5,965 participants, most of whom had CVD (mean age, 63 years; 35% women; 23% black) who were recruited from coronary angiography centers as part of the Emory Cardiovascular Biobank. Participants were stratified by HDL level: < 30 mg/dL; 31-40 mg/dL; 41-50 mg/dL; 51-60 mg/dL; and > 60 mg/dL.
During a median follow-up of 3.9 years, 769 (13%) CV deaths or nonfatal MI events occurred.
Compared with a reference group with HDL of 50 mg/dL, risk for all-cause mortality, CV mortality and nonfatal MI was elevated among participants with HDL < 30 mg/dL (n = 825; HR = 1.62; 95% CI, 1.16-2.26) and among participants with HDL 60 mg/dL (n = 570; HR = 1.44; 95% CI, 1.01-2.06). This trend persisted after adjustment for age, race, sex, BMI, LDL level, smoking status, use of lipid-lowering therapy, and history of HF and diabetes, according to results presented here.
Participants with HDL in the 41- to 60-mg/dL range had the lowest risk for mortality and MI, Allard-Ratick said.
These results support findings from several large population-based studies, including a recent publication which found increased CV and all-cause mortality when HDL reached extremely high levels, as previously reported by Healio.com.
“Our results are important because they contribute to a steadily growing body of evidence that very high HDL cholesterol levels may not be protective, and because unlike much of the other data available at this time, this study was conducted primarily in patients with established heart disease,” Allard-Ratick said in a press release.
During the press conference, Allard-Ratick said more research is needed to elucidate the mechanisms of the observed association in this study.
“We really don’t know the ‘why’ behind this,” Allard-Ratick said. “Until we do know why, we really don’t know how to intervene on this. It’s important to look at other risk factors for heart disease and focus on the things we can control.”
Allard-Ratick added that, while the answer remains unknown, one possible explanation is that extremely elevated HDL may represent “dysfunctional HDL,” which may promote rather than protect against CVD. – by Regina Schaffer
Reference:
Allard-Ratick, M. HDL cholesterol — A moving target. Presented at: European Society of Cardiology Congress; Aug. 25-29, 2018; Munich.
Disclosure: Allard-Ratick reports no relevant financial disclosures.
Perspective
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Joep Perk, MD, PhD, FESC
This shows that simplifying the cholesterol debate is wrong. There are so many sub-fractions in cholesterol, and to only make it black and white — “good” cholesterol vs. “bad” cholesterol — it’s not as easy as that. This study suggests that very high levels of the so-called good cholesterol are not as protective as we once thought. The whole picture that we wanted to simplify is not so simple anymore. I would recommend not being so fixed on your cholesterol levels, and instead, focus on life habits. Cholesterol is a good indicator, but it’s not the complete picture.
Faculty of Health and Life Sciences
Linneus University, Kalmar, Sweden
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