Q: I am 55 years old. I jog 30 minutes five days a week, weigh 140 pounds and am 5’5” tall. I have been running for 29 years and have always considered myself healthy. Recently I had a stress test and blood work due to a family history of heart disease. My HDL reading was 134 and my LDL 108. No one seems to have seen an HDL this high and my cardiologist feels because my total cholesterol is 253, I should be on some type of statin.
I recently spoke with a pharmacist who is a proponent of a low/no carb organic diet and felt that my high HDL could be a sign of underlying diseases including autoimmune or thyroid disorder and possible liver and/or kidney disease. I do not have any health issues or allergies and was recently considered as a kidney donor for a relative.
My question is, what does a high HDL really mean. Should I be on a statin drug? Should I consider a low/no carb diet? And is a high HDL something I should be concerned about? I’m anxious for your opinion.
A: Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL). Those levels are broken down into total cholesterol, HDL (high density lipoproteins), and LDL (low density lipoproteins). As a point of information, LDL is now broken down into smaller units to gauge a person’s risk for coronary artery disease. Simplifying things, a total cholesterol below 200 mg/dL is desirable. Higher figures are considered out of the desirable range. HDL (the good cholesterol) figures at 60 mg/dL or greater are best, while lower counts are not as desirable. LDLs (the bad cholesterol) figures of up to 129 mg/dL or less are best, while higher figures are less desirable. Triglycerides below 150 mg/dL are most desirable while higher figures are less desirable. The American Heart Association prefers triglyceride levels of 100 mg/dL or lower as optimal for improved heart health; however, it does not recommend drug treatment to reach those lower levels. Instead, initial steps might include a reduction in weight, a stepped-up exercise program, and dietary modifications. LDL cholesterol can build within the walls of our arteries and may lead to blockages that, in turn, can lead to heart attacks. Higher HDL levels generally translate to a lower risk of cardiac incidents.
Elevated HDL levels may occur because of engaging in an extensive aerobic exercise program, being on oral estrogen replacement therapy, a history of chronic alcoholism, and the use of niacin, fibrates and statins. Very high levels of HDL cholesterol may have a paradoxical effect that is not entirely clear. HDL cholesterol is used in the assessment of coronary or other vascular pathology risk. The reference range of HDL-C (cholesterol) is between 40 and 50 mg/dL in men and between 50 and 60 in women. Increased levels may indicate such conditions as weight loss, chronic liver disease, the use of insulin, the exercise program mentioned above, and hyperalphalipoproteinemia (HALP for short), a mouthful of a word that simply implies the presence of inherited abnormally high levels of HDL in serum. Statins may increase levels minimally. HALP has no specific symptoms and is usually identified through the assessment of a lipid profile. Familial HALP may result in protection from coronary heart disease and is occasionally associated with multiple symmetric lipomatosis, juvenile corneal opacification, alcohol abuse, vigorous exercise, and the medications described above.
As a point of information and according to some researchers, total cholesterol levels are calculated by adding the HDL, LDL, and 20% of the triglyceride level. I don’t question your physician but it might be interesting to calculate your own total cholesterol count utilizing this formula. Still other formulas to determine cardiac risk do not consider the HDL. Known as non-HDL-C, it is defined as the difference between the total cholesterol and HDL-C. Non-HDL-C includes all cholesterol present in lipoprotein particles considered bad for the arteries of the heart and includes LDL and other sub-particles that would have to be specifically ordered. It has been suggested that the non-HDL-C fraction may even be a better tool for risk assessment than LDL-C.
Because statins can contribute to elevated HDL counts, I feel it is important for you to enlist the services of a local top-notch cardiologist before a decision is made. He or she should review your recent laboratory testing and discuss the situation in depth.
Readers who are interesting in learning more can oder Dr. Gott’s Health Report “Understanding Cholesterol” by sending a self- addressed, stamped number 10 envelope and a $2 Us check or money order payable to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
