Can too much of a great thing ever be bad – at least when it comes to HDL cholesterol?

This is the “good” cholesterol that’s supposed to be high. But if it’s as high as a kite, does that mean more good or harm?

“When it comes to protecting one’s heart, high density lipoprotein cholesterol — or HDL — has long been considered the ‘good’ cholesterol, compared to the ‘bad’ cholesterol, i.e., LDL (low density lipoprotein),” begins says Morton Tavel, MD, Clinical Professor Emeritus of Medicine, Indiana University School of Medicine, and author of “Health Tips, Myths, and Tricks: A PHYSICIAN’S ADVICE.”

Dr. Tavel continues, “At least one recent study [Emory University School of Medicine] suggests that there could be too much of a ‘good’ thing, that is, very high blood levels of HDL cholesterol may actually be bad for you.

“This research linked high levels to an elevated risk for heart attack and even death.

“These researchers found that patients with HDL levels in the middle range of the spectrum — between 41 to 60 mg/dL of blood — fared the best, having the lowest risk for heart attack or death from heart disease.

“By contrast, those with HDL readings outside of this range, below 41 or above 60, faced a markedly increased risk for both unfavorable health outcomes.

“Specifically, patients with HDL levels exceeding 60 were found to have a 50 percent greater risk of heart disease death or heart attack, compared with those in the middle range.

“Surprisingly, this increased risk of death or cardiovascular disease was seen more commonly in women compared to men.”

What makes these findings remarkable is that the study adjusted for other risk factors for cardiovascular illness and related mortality!

• Diabetes
• Drinking
• High “bad” cholesterol (LDL)
• Smoking
• Various other risk factors

Why the association exists between higher HDL and increased risk of heart disease and heart attacks is still not known. But the association cannot be ignored.

Dr. Marc Allard-Ratick, study author of the Emory investigation, believes that extremely elevated HDL my indicate a “dysfunctional HDL” which encourages coronary artery disease rather than protects against it.

Other Studies As Well

“Prior studies had shown that when compared to those with more moderately high HDL levels, people with ‘very high’ HDL levels — meaning a threshold of 90 mg/dL or more — appear to face a greater risk for heart disease,” explains Dr. Tavel.

“So we remain uncertain about which levels are truly bad.”

Another recent study (University of Copenhagen) links very high levels of the good cholesterol with increased mortality.

• Men with extremely high HDL levels had a 106 percent higher mortality rate than those with a normal HDL level.

• Women with extremely high HDL had a 68 percent higher mortality rate than did the normal group.

• Men with very high levels – but not “extremely” high, had a 36 per cent higher death rate.

• Subjects with extremely low HDL also had a high death rate.

• And who had the lowest mortality of both genders? Those with a moderate level of the good cholesterol.

Professor Børge Nordestgaard, one of this study’s authors, advises that people not get caught up with trying to get their HDL as high as possible.

He points out in the paper that HDL’s are the smallest of the lipoproteins, and that we need to pay more attention to the bigger lipoproteins like LDL and triglycerides.

What Should You Do?

Don’t freak when your lipid panel shows an HDL in the 40s. Don’t try all sorts of supplements, bitter tasting herbs, odd-tasting plant roots and forcing down raw vegetable juice in an attempt to jump the HDL into the 70s.

But do keep taking your aged garlic extract, eating wild-caught fish, lots of fresh vegetables and fruits, and restricting processed foods. And get lots of exercise.

“So what can we do about the various elevated levels?” begins Dr. Tavel. “Since the implications of this finding remain unclear, the appropriate management is not known at this time.

“Patients with very high HDL cholesterol should continue to address other modifiable risk factors — such as high blood pressure, smoking and obesity — to reduce cardiovascular disease. More definitive answers await more research.”

morton tavel, MD

Dr. Tavel’s medical research includes over 125 publications, editorials and book reviews in peer-reviewed national medical journals. He was formerly director of the cardiac rehabilitation program at St. Vincent Hospital in Indiana.