Predicting Heart Disease Risk with ‘Good’ Cholesterol: Is it Still Viable?
Until now, it has been widely believed that lower levels of high-density lipoprotein (HDL) or ‘good’ cholesterol is associated with an increased risk of heart attacks. Now, a National Institutes of Health-supported research has found that ‘good’ cholesterol levels may not be as effective in predicting cardiovascular disease among adult populations of different racial and ethnic groups.
Published in the Journal of the American College of Cardiology, the study found that the long-accepted association was evidenced only in a white adult population; it did not pertain to Black adults. Furthermore, higher levels of HDL cholesterol were not seen as protective for either group.
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In an official press release statement, Nathalie Pamir, a senior author of the study and Associate Professor of Medicine at the Knight Cardiovascular Institute at Oregon Health & Science University, Portland said: “the goal was to understand this long-established link that labels HDL as the beneficial cholesterol, and if that’s true for all ethnicities.”
Pamir continued by explaining how “it’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions.” For this, the data of 23,901 adults from the United States who previously participated in the Reasons for Geographic and Racial Difference in Stroke Study (REGARDS) was reviewed.
Researchers found that perceptions of low HDL cholesterol level as a biomarker for heart attack risk are outdated and not inclusive enough. In fact, many studies responsible for shaping this belief date back to the 1970s and had a primarily all-white study participant population.
Researchers found that perceptions of low HDL cholesterol level as a biomarker for heart attack risk are outdated and not inclusive enough.
By reviewing the between collected from the REGARDS study between 2003 to 2007, the National Institutes of Health-supported study looked at the cholesterol levels of both Black and white, middle-aged adult populations. These participants did not have heart disease and were recruited from various locations in the US. The data showed that during REGARDS, 664 Black adults and 951 white adults experienced either a heart attack or died from a heart attack-related death.
Overall, adults with increased low levels of HDL cholesterol had a moderate increased risk. While this finding aligned with previous research and perceptions, it showed that the predictive association was only relevant to white participants, implying that high HDL cholesterol cannot always be accurately used as a biomarker for reduced cardiovascular events.
Zakai NA, Minnier J, Safford MM, et al. Race-dependent association of high-density lipoprotein cholesterol levels with incident coronary artery disease. J Am Coll Cardiol. 2022; doi: 10.1016/j.jacc.2022.09.027.
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