A new study may upend long-standing assumptions about the role of high-density lipoprotein (HDL), or “good cholesterol,” in predicting heart disease risk across patient groups, according to the National Institutes of Health.
Researchers examined data from more than 23,000 US adults to see how HDL cholesterol measures overlapped with future cardiovascular events. The goal was to understand why coronary heart disease risk equations underperform in Black adults.
Low levels of HDL cholesterol predicted an increased risk of heart attacks or related deaths for white adults. But the same was not true for Black adults, they found. In addition, higher HDL cholesterol levels, historically thought to be beneficial, were not associated with reduced cardiovascular disease risk for either study cohort, the investigators reported.
It has long been accepted that low HDL cholesterol levels are detrimental, regardless of race, noted co-author Nathalie Pamir, PhD, of Oregon Health & Science University in Portland.
“Our research tested those assumptions,” she said in a statement.
“Although HDL-C clinical risk category cutoffs are well established for white populations, our findings expose the weaknesses in their use, because such categories might not apply to Black men and women, reducing their value in CHD risk assessment,” Pamir and colleagues wrote in the study.
No ‘pat on the back’?
The authors said that their research could help clinicians “revisit the risk-predicting algorithm for cardiovascular disease” and get them thinking differently about what these measures mean for patient health.
“It could mean that in the future we don’t get a pat on the back by our doctors for having higher HDL cholesterol levels,” she concluded.
Investigators found “modest” evidence, meanwhile, that low-density lipoprotein (LDL) cholesterol and triglycerides predicted coronary heart risk in Black and white adults.
The study was published in the Journal of the American College of Cardiology.
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