A recent study funded by the National Institutes of Health (NIH) suggests that "good cholesterol" may not be as reliable as previously thought in predicting the risk of cardiovascular disease in adults from various racial and ethnic backgrounds. According to new research supported by the National Institutes of Health, high-density lipoprotein, or HDL, cholesterol - frequently referred to as the "good" cholesterol - may not be as helpful in predicting the risk of heart disease and protecting against it as previously thought.
Study challenges”good”cholesterol’s role in universally predicting heart disease risk.
High concentrations of HDL cholesterol were linked to lower coronary heart disease risk, according to a research from the 1970s. This association has subsequently gained widespread acceptance and is utilized in heart disease risk assessments. However, that survey exclusively covered White Americans. White individuals, but not black adults, had greater risks of heart attacks linked with lower HDL cholesterol levels, and neither group benefited from higher levels of HDL cholesterol.
According to a study, high-density lipoprotein (HDL), also known as the "good cholesterol," may not be as useful in predicting cardiovascular disease risk in persons from various racial and cultural origins as previously thought. The National Institutes of Health provided funding for the study (NIH).
The study discovered that whereas there is a long-established relationship between low levels of HDL cholesterol and an increased risk of heart attacks or fatalities attributable to them in white individuals, this association was not present in black adults. Furthermore, neither group's risk of cardiovascular disease was lowered by greater HDL cholesterol levels. "The goal was to understand this long-established link that labels HDL as the beneficial cholesterol, and if that's true for all ethnicities," said Nathalie Pamir, Ph.D., a senior author of the study and an associate professor of medicine within the Knight Cardiovascular Institute at Oregon Health & Science University, Portland. The study was published on November 21 in the Journal of the American College of Cardiology. “It’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions.”
The majority of the cholesterol in your body is LDL (low-density lipoprotein), sometimes referred to as "bad" cholesterol. Your risk of heart disease and stroke increases if your LDL cholesterol levels are high. High-density lipoprotein, or HDL, cholesterol collects cholesterol in the blood and transports it back to the liver, earning it the moniker "good" cholesterol.
Pamir and her coworkers evaluated data from 23,901 American adults who took part in the Reasons for Geographic and Racial Differences in Stroke Study in order to do that (REGARDS). In the 1970s, research with a preponderance of white adult study participants helped shape perceptions about "good" cholesterol levels and heart health.
Participants in the study signed up for REGARDS between 2003 and 2007, and researchers examined data gathered over a ten- to eleven-year period. Participants in the research, both black and white, had similar age ranges, cholesterol levels, and underlying heart disease risk factors such diabetes, high blood pressure, and smoking. During this time, 951 white adults and 664 black adults died from heart attacks or conditions connected to them. According to earlier studies, those with higher levels of triglycerides and low-density lipoprotein (LDL) cholesterol were at slightly higher risk of developing cardiovascular disease.
The study was the first to discover, nevertheless, that higher cardiovascular disease risk was solely associated with lower HDL cholesterol levels among white individuals.Additionally, it adds to research that suggests high HDL cholesterol levels are not necessarily linked to a decline in cardiovascular events. The REGARDS analysis was the largest U.S. study to demonstrate that this was accurate for both black and white individuals, indicating that neither group may benefit from having higher than recommended levels of "good" cholesterol.
The need to review the risk-predicting algorithm for cardiovascular disease, Pamir said, is what he hopes his sort of study will prove. It could prevent our doctors from praising us in the future for having greater HDL cholesterol levels.
In order to better understand how HDL cholesterol promotes heart health, experts are examining a variety of possibilities, according to Pamir. Quality above quantity is one. That is, maintaining cardiovascular health may depend more on the quality of HDL's action, which involves removing extra cholesterol from the body, than on the quantity of HDL.
They are also examining HDL cholesterol's microscopic characteristics, including hundreds of proteins linked to the transport of cholesterol, to see if different connections based on a single protein or groups of proteins may enhance predictions of cardiovascular health.Sean Coady, a deputy branch head of epidemiology at the National Heart, Lung, and Blood Institute's Division of Cardiovascular Sciences, said HDL cholesterol has long been a mysterious risk factor for cardiovascular disease
“The findings suggest that a deeper dive into the epidemiology of lipid metabolism is warranted, especially in terms of how race may modify or mediate these relationships.”
The findings show that cardiovascular disease risk calculators utilizing HDL cholesterol might result in erroneous projections for black individuals, the scientists write. They also advocate continued and future research with various groups to examine these linkages. Heart disease risk factors cannot be confined to a single race or ethnicity, according to Pamir. They must be applied to all.
Low HDL cholesterol levels are harmful regardless of race, as is well acknowledged. In a news release, Nathalie Pamir, an associate professor of medicine at the Knight Cardiovascular Institute at Oregon Health & Science University, Portland, and a senior author of the study, said, "Our research examined such beliefs. It may imply that in the future, our physicians won't congratulate us for having greater HDL cholesterol levels. The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort collected data from thousands of participants. Participants' health was examined for an average of 10 years and they had to be at least 45 years old when they joined the program between 2003 and 2007. Current clinical evaluations for heart disease risk, they added, "may misclassify risk in Black individuals, possibly impeding appropriate cardiovascular disease preventive and treatment strategies for this group."
The associate director of the Lenox Hill Women's Heart Program and CNN Medical Correspondent Dr. Tara Narula said the study "highlights the very significant need for further race- and ethnic-specific research and that there is not a one-size-fits-all strategy. This study also highlights the ongoing need for education about the fact that excessive LDL levels and other recognized cardiovascular risk factors must be controlled while high levels of HDL are not a free pass.