Study Finds Lowering LDL More Effective Than Raising HDL

Low and very high levels of high-density lipoprotein cholesterol (HDL-C) may be associated with a higher risk of death from cardiovascular disease, cancer and other causes. In addition, a low level of good cholesterol may not be a cardiovascular disease risk factor on its own and raising HDL does not likely reduce a person’s risk of cardiovascular disease, according to a study published Oct. 31 in the Journal of the American College of Cardiology.

Dennis T. Ko, MD, MSc, et al. studied over 631,000 individuals without prior cardiovascular conditions through the CANHEART cohort. Patients were between 40 and 105 years old, with an average age of 57.2, and lived in Ontario for at least two years as of Jan. 1, 2008.

Researchers compared the HDL levels of people with healthier lifestyles to those with less healthy habits. The lowest levels of HDL were seen in people who were socioeconomically disadvantaged and who had less healthy lifestyle behaviors, more cardiac risk factors and more medical comorbidities. However, after adjusting for lifestyle factors, lower HDL levels were still associated with increased risk of both cardiovascular death and non-cardiovascular related death, such as death from cancer. Individuals with very high HDL levels had an increased risk of non-cardiovascular related death.

This study is among the first to show a similar relationship between HDL and cancer death and other causes of death. Ko and colleagues add that these findings casts doubt on HDL being used as an independent risk factor for cardiovascular disease or for raising HDL levels to be used by itself as an intervention to reduce the risk of dying from cardiovascular disease.

“The link between good cholesterol and heart disease is complex, but it seems certain that there is a connection between people with low good cholesterol levels and other well-known risk factors for heart disease such as poor diet and exercise habits and other medical conditions,” said Ko. “Focusing on raising HDL is likely not going to help these patients, but these findings show that one of the best interventions in treating and preventing heart disease continues to be lifestyle changes.”

In a related editorial comment, Stephen J. Nicholls, MBBS, PhD, FACC, and Peter J. Psaltis, MBBS, PhD, further explain that “What we have learned is that HDL is highly complex, circulating in a range of forms … When combined with reports that measures of the functional activity of HDL may be superior in their ability to predict cardiovascular risk when compared with HDL-C suggests that qualitative measures of HDL may be more important in terms of atheroprotection and therefore provides a shining light of hope that we may still find favorable approaches to targeting HDL to reduce cardiovascular risk.”

Clinical Topics: Clinical Topic Collection: Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet

Keywords: Cardiovascular Diseases, Cause of Death, Cholesterol, Comorbidity, Diet, Habits, Heart Diseases, Life Style, Lipoproteins, HDL, Neoplasms, Ontario, Research Personnel, Risk Factors, Vulnerable Populations


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