New Study Challenges ‘Good’ Cholesterol’s Role in Predicting Heart Disease Risk

BETHESDA, Md. — A new study has found that high-density lipoprotein cholesterol, the so-called “good cholesterol,” may not be as effective as scientists once believed in uniformly predicting cardiovascular disease risk among adults of different racial and ethnic backgrounds. 

In fact, the research, which was supported by the National Institutes of Health, found that lower levels of HDL cholesterol were associated with increased risks for heart attacks in White but not Black adults, and higher levels were not protective for either group.

The research was published in the Journal of the American College of Cardiology.

“The goal of this research was to understand this long-established link that labels HDL as the beneficial cholesterol, and if that’s true for all ethnicities,” said Nathalie Pamir, Ph.D., a senior author of the study and an associate professor of medicine within the Knight Cardiovascular Institute at Oregon Health & Science University, Portland. 

“It’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions,” she said.

To do that, Pamir and her colleagues reviewed data from 23,901 United States adults who participated in the Reasons for Geographic and Racial Differences in Stroke Study.

Previous studies that shaped perceptions about “good” cholesterol levels and heart health were conducted in the 1970s through research with a majority of White adult study participants. 

For the current study, researchers were able to look at how cholesterol levels from Black and White middle-aged adults without heart disease who lived throughout the country overlapped with future cardiovascular events.  

Study participants enrolled in the study between 2003 and 2007, and researchers analyzed information collected throughout a 10- to 11-year period. 

Black and White study participants shared similar characteristics, such as age, cholesterol levels and underlying risk factors for heart disease, including having diabetes, high blood pressure or smoking. 

During this time, 664 Black adults and 951 White adults experienced a heart attack or heart attack-related death. Adults with increased levels of LDL cholesterol and triglycerides had modestly increased risks for cardiovascular disease, which aligned with findings from previous research.  

However, the study was the first to find that lower HDL cholesterol levels only predicted increased cardiovascular disease risk for White adults. It also expands on findings from other studies showing that high HDL cholesterol levels are not always associated with reduced cardiovascular events. 

“What I hope this type of research establishes is the need to revisit the risk-predicting algorithm for cardiovascular disease,” Pamir said. “It could mean that in the future we don’t get a pat on the back from our doctors for having higher HDL cholesterol levels.”