Is Raising HDL Levels as Beneficial as Lowering LDL Levels?

Low and high levels of high-density lipoprotein (HDL) cholesterol, known as “good cholesterol,” are associated with increased risk of dying from heart disease, cancer, and other causes, according to the results of a recent study.

Many individuals are treated with statins to lower their low-density lipoprotein (LDL) cholesterol levels. However, some patients do not respond to statin treatment. Therefore, researchers have begun studying the effects of raising HDL levels, and whether the increase could be associated with similar benefits to lowering LDL levels.
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For their study, researchers used data from the Cardiovascular Health in Ambulatory Care Research Team dataset, created by combining 17 individual-level data sources. They included 631,762 individuals in the study, mean age 57.2 years, mean HDL level 55.2 mg/dl. Overall, there were 17,952 deaths during a mean follow-up of 4.9 ± 0.4 years.

The all-cause mortality rate was 8.1 per 1000 person-years for men and 6.6 per 1000 person-years for women.

Participants with lower HDL levels were more likely to have an unhealthy lifestyle, low income, higher triglyceride levels, other cardiac risk factors, and medical comorbidities. Lower HDL levels were independently associated with a higher risk of cardiovascular-related mortality, cancer-related mortality, and other mortality compared with reference ranges of HDL levels. Higher HDL levels (>70 mg/dl in men, >90 mg/dl in women) were associated with increased non-cardiovascular mortality.

“Complex associations exist between HDL levels and sociodemographic, lifestyle, comorbidity factors, and mortality. HDL level is unlikely to represent a [cardiovascular]-specific risk factor given similarities in its associations with non-[cardiovascular] outcomes,” the researchers concluded.

—Michael Potts

Reference:

Ko DT, Alter DA, Guo H, et al. High-density lipoprotein cholesterol and cause-specific mortality in individuals without previous cardiovascular condition. JACC. 2016;68(19):2073-2083.