I first had my cholesterol tested in my 20s and my HDL was 92. I am 50 now and just got it tested again (hadn’t had a test since my 20s!). Anyway my numbers now are as follows: HDL 121, LDL 90, for a total of 211.
My doctor thought it was great and said he’d never seen an HDL so high (he’s an internist not a cardiologist). I did some googling and found sites that said that HDL too high is a bad thing so now I’m confused.
Is there a doctor or other expert in the house who can give me the straight dope?
By and large the only liability associated with having high levels of HDL cholesterol is that you’re liable to live to 100 (or more) so be sure to take care of yourself.
In every study I’ve seen, there has been a clear and direct relationship between HDL level and longevity. Perhaps not too surprisingly is the consistent observation that people with high HDL levels are overrepresented in centenarians compared to people with lower HDL levels.
I suppose there may be exceptionally rare variants where a person’s HDL is dysfunctional and not only doesn’t work as it should, but also resists being cleared out of the system (i.e. it would build up and cause high levels even though it wasn’t doing the usual good things that HDL is thought to do). I emphasize that such variants are RARE.
How does HDL confer protection against atherosclerosis (and against other aspects of aging)?
HDL carries cholesterol away from the tissues and then to the liver for excretion from the body (this is the classic mechanism, so-called 'reverse cholesterol transport)
HDL cholesterol being elevated is in part an epiphenomenon, i.e. the HDL got so high by virtue of taking cholesterol away from LDL (and other cholesterol containing particles)
HDL may have on it various antioxidant (and possibly other protective) molecules
HDL elevation is usually associated with low triglyceride levels
HDL elevation may also be a marker for other, generally healthy factors e.g. non-smoking, non-obese, non-hyperinsulinemic, physically fit individuals
Well damn, I first read KarlGauss’s post and rejoiced. Then I read Surreal’s and now I’m back to being confused. FYI my liver enzymes were “normal”… so hopefully I’ll just live to be 100.
But if anyone else would like to weigh in, I would appreciate it.
Although there seems to be a link at a population level between high HDL and elevated liver enzymes, it’s worth noting that the elevation of the latter was very, very modest.
Moreover, although called “live enzymes” in the study, the same enzymes are found in other tissues including muscle. So, for example, it is possible that some of the association between high HDL and high “liver enzymes” is really an association between high HDL and a minor degree of muscle inflammation - around the degree seen after vigorous exercise, an activity that leads to higher HDL (and thus which provides a possible mechanism for the association).
Most importantly, even if the elevation in enzymes does reflect some degree of liver inflammation, the bottom line is that, on average, people with high HDL liver longer than those with lower levels. In other words, any putative liver abnormality associated with high HDL levels would seem to be of marginal, if any, clinical significance.
The Framingham study and its scientists may disagree with your characterization of an HDL level of 121 as “silly”. Specifically, Framingham data had the upper limit of HDL for men at 129 and, for women, at 139. (CITE).
In any case, in the absence of evidence suggesting a deleterious effect of very high HDL levels (the “liver enzyme” cite above notwithstanding), and in the presence of a mountain of data linking high HDL to reduced atherosclerosis and to longevity, it does not seem unreasonable to extrapolate by saying that people with very high HDL levels, similar to those with merely high levels of HDL, are likewise at reduced risk of atherosclerosis.
And, please note, I am not trying to say that acting to raise HDL levels (whether achieved by medical or non-medical means) confers a benefit. I am simply saying that I am unaware of evidence to suggest that very high HDL levels differ from merely high HDL levels in terms of health benefits. As always, I stand to be corrected.
Let’s back up for a minute here. The OP’s internest said that he’d never seen an HDL level so high. I don’t know how much experience the OP’s physician has, but right away that’s red flag. Extreme values (high or low) for any biomarker are more likely to indicate disease rather than superb health. Mortality curves are often “U” shaped.
Note that they lump a huge range of HDL values into the top quintile. For men the top quintile had an HDL range of 55 mg/dl all the way to 159 mg/dl. That’s from 0.75 standard deviations above the mean to 8.5 SDs above the mean. There’s insufficient data to make any specific claims about HDL levels higher than 3 SDs above or below the mean.
If the OP is a male, his 121 HDL would be 5.7 SDs above the mean. If she is female, her HDL is 4.1 SDs above the mean. Extremely rare.
Yes 17 months after that test, I’m still alive & kicking. FTR I’m female, so Surreal, please dumb it down for me. What non-CV events/diseases can kill me due to my high HDL?
And is there a way to reduce your HDL? My diet mostly consists of lean meats, fish, & vegetables & I exercise almost every day. Should I eat less fish? I have an extremely healthy lifestyle (except for the booze I consume on weekends), so I’d like to live til 100 if at all possible.
I don’t think it’s the HDL itself that puts you at risk, more likely it’s just a marker of some type of underlying pathology. Similarly there have been a number of trials of drugs designed to raise HDL in people with low HDL in order to reduce cardiovascular events and none of them have worked.
That said, once I found out that my HDL is in the high range (80-100 mg/dl, male), I cut back on foods high in lauric acid (coconut oil, palm oil, etc.) in order to keep my HDL down.