Low HDL Level Means Higher Heart Risk

A study by an international team of researchers suggests that regardless of the level to which “bad cholesterol” is reduced, having proper amount of “good cholesterol” is very important to keep the risk of heart disease down.

The study published in the New England Journal of Medicine was conducted by Dr. Philip Barter of the Heart Research Institute in Sydney and colleagues. They studied 9,700 patients taking the statin medication Lipitor and found that the higher a patient’s HDL, the lesser were his or her chances of having a major cardiovascular event such as a stroke or heart attack.

According to Dr. Barter, their finding is important as “it shows very clearly that the risk is real” when the levels of “HDL” – the good cholesterol are too low. “It means doctors can’t ignore a low HDL even if they’re treating people with statins. They need to attack the HDL as well, if the HDL remains low,” Dr. Barter said.

The medical fraternity has been aware for years that HDL – high density lipoprotein cholesterol – can provide protection against heart attacks and stroke. While the exact reason behind this is not known, doctors believe it might on account of HDL cleaning up the bad LDL – low density lipoprotein cholesterol.

“But it has not been clear whether a low HDL cholesterol level would remain a significant risk factor in people whose LDL cholesterol was reduced to very low levels,” the researchers said. “Indeed, it had been argued hypothetically that if the LDL cholesterol levels were reduced sufficiently, the level of HDL cholesterol might become irrelevant,” they added.

"Even when LDL is taken down to very low levels, the kind of levels people say should be the aggressive targets, having a low HDL is still associated with a substantial increase in risk,” Dr. Barter said. “It surprised a lot of people and it surprised me.”

However, it is very tough to raise HDL levels. Niacin, the only drug that does it also has certain worrisome side effects. All efforts to develop medications that increase HDL cholesterol levels have so far been unsuccessful.

According to Dr. Barter, the only alternative is to “become lean and become very active. That’s probably as effective as anything we have at the moment. But most people who try don’t succeed. The biggest frustration is that we don’t have the magic bullet like we do for the LDL.”

In Dr. Barter’s opinion, it might be possible to lower the risk of heart disease and stroke by 40-50% by aggressively lowering levels of LDL. However, if a drug that boosts HDL levels could be developed, even the remaining risk could be cut down by another 50%.

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