Is low HDL a problem when you have low LDL?

[Gary_Robson]

I’ve been perusing medical sites trying to get an answer to this but I haven’t found anything that really makes it clear to me. Can anyone explain it to me?

I just got back lab results from my latest checkup. My total cholesterol is 170 (*), and LDL (“bad” cholesterol) is 116. Everything I read, says this is marvelous. My HDL (“good” cholesterol) is 38, which everything I read says should be quite a bit higher. Depending on the source, it’s anything from “poor” to “significant risk of heart problem.”

Here’s what I don’t get: My understanding is that the reason HDL is good is that it helps to lower LDL. If my LDL is already low, why does the HDL matter? Is it actually a problem?
(*) I’m in the U.S., so all of these numbers are in mg/dL. To put the numbers in perspective, I’m 54 years old, 6’5" tall, and weigh over 250 pounds.

[CandidGamera]

If you find out, let me know. My LDL’s always been good, but my HDL bottomed at 33 one year. It’s gone back up since I started regular exercise, but I think it wasn’t far above the 40 that is considered the low end of ‘normal’, even still.

[Voyager]

I’m in the same boat. I’ve got crazy low LDL, but my HDL was a bit low. My doctor was getting upset, when this report came out. As far as I can tell, you can’t do much about low HDL anyhow except exercise (and I’m at a good weight so screw it) and drinking red wine. My HDL popped up above the lower limit for no apparent reason.

[Gary_Robson]

@Voyager

As far as I can tell, you can’t do much about low HDL anyhow except exercise (and I’m at a good weight so screw it) and drinking red wine.

Treadmill and a hearty Zinfandel and all is well?

[Ann_Hedonia]

[quote=“Gary “Wombat” Robson, post:1, topic:650713”]

I’ve been perusing medical sites trying to get an answer to this but I haven’t found anything that really makes it clear to me. Can anyone explain it to me?

I just got back lab results from my latest checkup. My total cholesterol is 170 (*), and LDL (“bad” cholesterol) is 116. Everything I read, says this is marvelous. My HDL (“good” cholesterol) is 38, which everything I read says should be quite a bit higher. Depending on the source, it’s anything from “poor” to “significant risk of heart problem.”

Here’s what I don’t get: My understanding is that the reason HDL is good is that it helps to lower LDL. If my LDL is already low, why does the HDL matter? Is it actually a problem?
(*) I’m in the U.S., so all of these numbers are in mg/dL. To put the numbers in perspective, I’m 54 years old, 6’5" tall, and weigh over 250 pounds.
[/QUOTE]

My issues are the opposite. I once got a total cholesterol reading of 225, but LDL was 115 and HDL was 100. My doctor read this as EXCELLENT.

I must’ve had some fatty meals in the days before that test because I typically run about 175 but I’ve never had an HDL under 80. It’s never actually topped my LDL but it has been close.

[brazil84]

[quote=“Gary “Wombat” Robson, post:1, topic:650713”]

I’ve been perusing medical sites trying to get an answer to this but I haven’t found anything that really makes it clear to me. Can anyone explain it to me?
[/quote]

I researched this pretty carefully over the last few months. Surprisingly little is known about the health significance of low cholesterol.

One problem is that low cholesterol is sometimes caused by serious health conditions and sometimes just the result of people having naturally low cholesterol.

My amateur, non-scientific, non-professional advice to you is to discuss this with blood relatives who have had blood tests done. See if their cholesterol profile is similar to yours and if so, what sorts of health problems they have had. This may give you some insight into your own situation.

[doubleminus]

The whole “cholesterol as a cause” for disease in in a complete mess right now. Nowadays it is even not clear whether statins work because they lower cholesterol or for another reason. Regarding high HDL, it seems that people having high HDL have a lower incidence of CV events, but the casual link is not proved. A recent potential drug (torcetrapib) that raised the HDL was abandoned, since in trials it increased the incidence of heart-attacks.

Nevertheless, physical activity usually increases HDL, and the level you have might indicate couch potatodness.

Another very important lipid to check is triglycerides. If it’s too high, cut carbohydrates and get moving.

[Gary_Robson]

@doubleminus

Nevertheless, physical activity usually increases HDL, and the level you have might indicate couch potatodness.

I have, indeed, been spending too much time in front of a desk for the last six months, and I’ve put on 20 pounds. I just started up an exercise program about a week ago, so that should help things.

@doubleminus

Another very important lipid to check is triglycerides. If it’s too high, cut carbohydrates and get moving.

My triglyceride level is 78 mg/dL, which is pretty good, so I’m not worried about that. I am, however, cutting way back on processed grain and fried foods.

[barbitu8]

HDL does not lower LDL. Your cholesterol counts are terrible. HDL should be over 50 and LDL under 100. Total cholesterold should be under 200; however, if you have a very high HDL count (e.g., 90 or 100) your total cholesterol may be slightly higher than 200. Low HDL with low LDL just compounds the problem. Even a total cholesterol count of 170 is not good when your LDL is so high and your HDL so low.

To complicate matters, there are several types of LDL, and its the very low LDL that is most worrisome. It’s this type that can clog your arteries. HDL helps clear your arteries.

[Michael63129]

@doubleminus

The whole “cholesterol as a cause” for disease in in a complete mess right now. Nowadays it is even not clear whether statins work because they lower cholesterol or for another reason. Regarding high HDL, it seems that people having high HDL have a lower incidence of CV events, but the casual link is not proved. A recent potential drug (torcetrapib) that raised the HDL was abandoned, since in trials it increased the incidence of heart-attacks.

Nevertheless, physical activity usually increases HDL, and the level you have might indicate couch potatodness.

Another very important lipid to check is triglycerides. If it’s too high, cut carbohydrates and get moving.

To make matters more confusing, things aren’t as simple as “HDL” and “LDL”; there are actually different kinds of each and a high LDL doesn’t necessarily mean a higher risk of heart disease (nor is a high HDL level always good). For example:

The answer comes down to the diversity of LDL. For years, it has been an easier sell to label LDL cholesterol as one big bad thing — “the bad fat.” But researchers have always known that LDL is, in fact, a disparate array of particles, and thanks to early work by Krauss and others, they have long known that different forms of LDL react differently to foods in the diet and in relationship to heart disease. Small LDL is bad stuff, largely because it tends to rise in concert with the lowering of HDL. Small LDL, moreover, rises due to an elevation in triglycerides brought on by carbohydrates in the diet.

(there again is the mention of carbs (refined) and trigycerides, and also the “really bad” LDL; by contrast, saturated fat mainly affects large LDL particles which don’t appear to be dangerous, as well as raising HDL levels)

Conversely, you can have a too-high HDL level:

While we’ve come to assume HDL cholesterol is an inherently good thing, a new study shows that for a certain group of patients, this is not always the case. The study is the first to find that a high level of the supposedly good cholesterol places a subgroup of patients at high risk for recurrent coronary events, such as chest pain, heart attack, and death.

[barbitu8]

http://www.drmirkin.com/heart/8892.html

I should add that both exercise and alcohol increase HDL, along with niacin.

[barbitu8]

@Michael63129

Conversely, you can have a too-high HDL level:

From your first link:

Conclusions: The monounsaturated and polyunsaturated fat diets were healthier, producing a better lipid profile. The n-3 polyunsaturated fat diet increased the capacity of serum to promote the efflux of cholesterol from cells in culture.

Introduction:
The incidence of cardiovascular disease (CVD), the main cause of death and morbidity in developed countries (1), is closely related to diet, mainly to fat composition. The type of fat in the diet can modify the lipid profile, which is directly related to the growth of atheroma plaque (2, 3). In Spain, the mortality rate due to this disease is relatively low compared with that in other developed countries (4, 5). This finding could be explained by 2 facts: the Spanish diet is rich in vegetables, fruit, fish, and oils containing monounsaturated fatty acids (MUFAs), a regimen considered favorable for cardiovascular health (6), and Spaniards have elevated plasma concentrations of HDL (7).

From your 2d link:

Patients in the high-risk subgroup were characterized as having high levels of C-reactive protein (CRP), a well-known marker of inflammation, in addition to high HDL cholesterol. Study authors believe genetics and environmental factors, particularly inflammation, influence whether high levels of HDL cholesterol are protective or if they increase cardiovascular risk in individual patients. Given an inflammatory environment, an individual’s unique set of genes helps determine whether HDL cholesterol transforms from a good actor to a bad actor in the heart disease process.

In the high-risk subgroup of patients with elevated HDL cholesterol and CRP, researchers also identified two genetic factors associated with recurrent coronary events. The activity of cholesterol ester transfer protein (CETP), which moves cholesterol away from the vascular system and is associated with HDL cholesterol, and p22phox, which influences inflammation-related processes and is associated with CRP, are both risk predictors in this subgroup of patients.

[doubleminus]

Come on barbitu8. The guy is perfectly fine, cut him some slack.

I would propose a well-known prescription:

I read the prescription. It ran:

“1 lb. beefsteak, with
1 pt. bitter beer

                                                        every 6 hours.

1 ten-mile walk every morning.

1 bed at 11 sharp every night.

And don’t stuff up your head with things you don’t understand.”

The 10 mile walk seems undue harsh; 3 miles will suffice.

[D18]

There are some doctors and researchers who argue that it is the ratio of the HDL to LDL that matters in terms of risk. Cite. That said there are those that argue that the whole HDL to LDL ratio was a ploy by AstraZeneca to differentiate Crestor from Lipitor. See, Crestor raises HDL marginally and lowers LDL a truck load. But the HDL raising on its own wasn’t enough to market, but when you look at the ratio, then they had something they could sell against.

If you want to put your cholesterol levels into a more comprehensive risk assessment, you may have fun with the Framingham Risk Score or the Reynolds Risk Score. These will tell you the likelihood of having a heart attack or stroke in the next 10 years.

[Gary_Robson]

@barbitu8

HDL does not lower LDL. Your cholesterol counts are terrible. HDL should be over 50 and LDL under 100.

Gosh, thanks. You are quite the little ray of sunshine.

Your assessment of my LDL does seem at odds with other reputable sources, including my doctor, who said that my LDL should be between 82 and 168; the Mayo Clinic, which calls my level of 116 “near ideal;” the National Institutes of Health, which refers to my level as “near optimal/above optimal;” and WebMD, which says the same as NIH. None would classify it as “terrible.”

Your flat statement that HDL does not lower LDL doesn’t match with the sources I read yesterday, either. The WebMD link above says:

[QUOTE]
This is because HDL cholesterol protects against heart disease by taking the “bad” cholesterol out of your blood and keeping it from building up in your arteries./QUOTE]
Obviously, that’s a simplification, but is it completely wrong?

[D18]

ETA - C-reactive protein was mentioned up thread. As far as I know, this was motivated by the Jupiter Trial, which was run by AstraZeneca. It showed that in patients with normal LDL-C levels, but elevated c-reactive protein levels, that Crestor could reduce the risk of CV events.

[Michael63129]

@barbitu8

From your first link:
From your 2d link:

It’s interesting to note the following (keeping in mind the fatty acid profile of meat, especially red meat, and dairy, the latter which is about 2/3 saturated compared to about 1/3 for most meats):

A new study shows eating processed red meat – such as hot dogs, bacon, sausage, and cold cuts – is linked to increased risks of heart disease and diabetes. But the study, published in Circulation, shows no such link for unprocessed red meat.
From meta-analysis of 15 studies the relative risk of stroke and/or heart disease in subjects with high milk or dairy consumption was 0.84 (95% CI 0.76, 0.93) and 0.79 (0.75, 0.82) respectively, relative to the risk in those with low consumption. Four studies reported incident diabetes as an outcome, and the relative risk in the subjects with the highest intake of milk or diary foods was 0.92 (0.86, 0.97).

Note also that both of these were more than just simple studies; the processed meat one was based on 20 different studies and the milk one 15 (i.e. much more reliable than just one study, same for this paper on dairy fat which finds either no or inconsistent results for fat consumption).

Also of note, the processed meat study found a whopping 42% increase in CVD risk from just 2 ounces a day - suggesting that meat-eating is a major risk factor for CVD (as vegetarians and vegans so often like to claim) - but only because of the kind of meat people eat (i.e steaks and hamburgers, preferably lean, are okay but not bacon, lunch meat, hot dogs, sausages, etc).

And no, I’m not saying that you can eat as much saturated fat as you want since of course your body needs omega-3/6 fats (called essential fatty acids for that reason). It just shouldn’t come from processed foods (which provides a majority of the average American’s fat intake), only natural foods (and of course, said foods are often loaded with other bad stuff).

[rhubarbarin]

From my understanding, it’s the ratio between HDL and LDL which have the most reliable correlations with long-term health outcomes. According to this research, you definitely want to raise your HDL, even though your total and LDL are in good range.

However, this stuff is far from an exact science. New research is coming out all the time, and there are reputable professionals in the field who have almost exactly opposing opinions.

[Hirka_T_Bawa]

[quote=“Gary “Wombat” Robson, post:1, topic:650713”]

I just got back lab results from my latest checkup. My total cholesterol is 170 (*), and LDL (“bad” cholesterol) is 116. Everything I read, says this is marvelous. My HDL (“good” cholesterol) is 38, which everything I read says should be quite a bit higher. Depending on the source, it’s anything from “poor” to “significant risk of heart problem.”

Here’s what I don’t get: My understanding is that the reason HDL is good is that it helps to lower LDL. If my LDL is already low, why does the HDL matter? Is it actually a problem?
(*) I’m in the U.S., so all of these numbers are in mg/dL. To put the numbers in perspective, I’m 54 years old, 6’5" tall, and weigh over 250 pounds.
[/QUOTE]

Honestly, this all depends on the rest of your profile. Basically, high LDL is a risk factor for stroke or heart attack, your LDL is low enough I would not worry about it. Your HDL is borderline (though, low LDL is associated with low HDL [obviously] so wouldn’t worry). The “normal” range for HDL is 40 to 60, while being above 60 is actually considered a Negative risk factor (i.e. gets rid of one of the other risks for stroke / heat attack).

Are you a smoker? Do you [currently] have high blood pressure? Are you on high blood pressure medications? If you answer yes to those three questions, then I would be worried. Otherwise, your cholesterol seems great.
Hirka T’bawa, PharmD.

[Surreal]

[quote=“Gary “Wombat” Robson, post:1, topic:650713”]

My HDL (“good” cholesterol) is 38, which everything I read says should be quite a bit higher.
[/QUOTE]

If you want to raise your HDL (which is actually a lipoprotein, not a “cholesterol”), the easiest way to do so is to consume more fat, particularly saturated fat:

http://atvb.ahajournals.org/content/12/8/911.abstract?ijKey=adcbb65f6dc408c34108ffe0106e0c0b1ba749d3&keytype2=tf_ipsecsha

All fatty acids elevated HDL cholesterol when substituted for carbohydrates, but the effect diminished with increasing unsaturation of the fatty acids.

The fact that saturated fat raises HDL causes a great deal of cognitive dissonance for the people who believe that saturated fat is somehow unhealthy.