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Can You Have Too Much 'Good' (HDL) Cholesterol?

A new study suggests that too much "good" cholesterol may be just as bad as too little. Dr. Sanaz Majd joins Nutrition Diva to sort out what this new research means for our heart health and risks.

By
Monica Reinagel, MS, LD/N, CNS,
Episode #496
image of good and bad cholesterol

A couple of weeks ago, I had some basic blood work done for my routine physical. All the numbers looked pretty good, but my doctor and I were high-fiving each other about my HDL score, which was 88 mg/dL.

Just by way of a quick review, there are lots of different kinds of cholesterol in your blood, and HDL (which stands for high density lipoprotein) is the one we often refer to as the “good” cholesterol. We don’t want it to be too low because having an HDL level below 40 mg/dL puts you at increased risk for heart disease. And that’s why you’ll find several articles in the Nutrition Diva podcast with strategies for increasing your HDL

So, I was feeling pretty smug about having an HDL level that was almost twice that target. But then a couple of days later, a new study came out with some surprising findings.

Although low HDL levels are a risk factor for heart disease, this study found that very high HDL levels (such as mine) may not be cause for celebration. In this study, those with HDL levels higher than 60 also had an increased risk for heart attack or death due to heart disease.

My first call was to my friend and physician Dr. Sanaz Majd to ask her whether or not having high HDL levels is something we need to worry about.

If the name sounds familiar, Dr. Majd was formerly the host of the House Call Doctor podcast here on the Quick and dirty tips network and now has a YouTube channel called Majd MD.

The highlights of our conversation are below;  just click on the audio player at the top of the page to hear the entire thing.

Nutrition Diva: So, Sanaz, how worried do we need to be about high HDL levels?

Dr. Majd: Well, Monica, if you’re in trouble, then I’m in worse shape—my HDL is 108!

There are some other studies suggesting that very high HDL levels may increase your risk. And there are other studies that show the opposite! It’s not enough to really change our practice on cholesterol at this time, but it’s enough to get a conversation rolling on this.

We need further research on exactly how to tell if high HDL is “dysfunctional” HDL that might dispose us to increased heart disease risk. The question really is: Does everyone with very high HDL have dysfunctional HDL? Or simply a subset?

ND: Before you go on, can you help me understand what you mean by dysfunctional HDL? I’ve written in the past about how the size and shape of cholesterol particles may be an important factor in whether or not they increase your risk. Is this a similar situation?

SM: Yes, exactly. It’s only a hypothesis, but the theory is that even though there’s more good cholesterol, the particles aren’t really functioning as they are supposed to.

MR: Tell us what this latest study was all about.

SM: The study researched almost 6,000 people with already established heart disease and an average age of 63. They found that HDLs over 60 mg/dL carried a nearly 50% higher risk of dying from a heart problem when compared to those with levels between 41-60.

It doesn’t really tell us anything for the rest of us who are perhaps younger and without heart disease. I wouldn’t lose sleep yet over high HDL levels if your other cholesterol numbers are at target and you do not have heart disease or risk factors for heart disease.

MR: That’s reassuring. Because the things that are associated with higher HDL levels are generally healthy habits. For example, when people are trying to boost low HDL levels, I suggest that they lose weight if they need to, exercise, eat more fiber. And I can’t see advising anyone to gain weight, exercise less, and eat less fiber in order to bring down their HDL!

But what about those who do have high LDL cholesterol or heart disease or other risk factors? Should they be worried about high HDL levels?

SM: Currently, treatment guidelines are still primarily targeted to reduce LDL (which is the bad cholesterol) and not to worry about HDL one way or the other. We’d need more data to change this practice guideline on a clinical level. So even though it’s something to think about, it’s not enough to change how we treat heart disease or heart disease risk factors.

MR: Thanks again to Dr. Majd for joining me today. For more of Dr. Majd’s advice and help in understanding the latest medical headlines, check out her new YouTube channel, Majd MD.

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