Over the last thirty-five years, numerous animal studies and clinical trials have demonstrated an inverse relationship between high-density lipoprotein (HDL) and heart disease. That is, the lower one’s HDL level, the higher one’s risk of developing heart disease. Doctors have reasoned that if having a low HDL level is bad, then having a high HDL level must be good–hence HDL is often referred to as “good cholesterol.” Accordingly, doctors have long prescribed niacin, which raises HDL levels, in hopes of preventing heart disease. But in the past few years, some large-scale human trials have shown that using medications to increase HDL levels doesn’t actually prevent heart attacks or strokes in high-risk patients, causing us to question whether having high HDL is truly beneficial.
HDL’s reputation as “good cholesterol” has been further tarnished by a study published yesterday in The Lancet. The study showed that people who naturally have very high levels of HDL (because of a genetic variation) are just as likely to develop heart disease as people with lower HDL levels. As health care providers, the results of the analysis give us pause. How this new information will affect our approach to preventing heart disease is very much up in the air right now, but as always, we will keep you informed as we analyze the details of the new study. Stay tuned!