Another Cholesterol Question with a twist - UPDATE - Got Cardiac Calcium Score

Your PCP is likely mistaken just like the people who have said for decades that your high HDL is protective against CVD. High HDL is neither dangerous or protective. Peter Attia has a podcast with lipid researcher Dan Rader that goes deep into HDL and is worth a listen. LINK

Low HDL on the other hand is associated with increased CVD risk and is usually caused by insulin resistance. Insulin resistance drives the increased CVD risk though not the low HDL.

Sure. Post the studies they referenced if you have them, would like to read them.

I did some reading and I don’t see any good reason for concern.
1) the studies are observational and even the authors caution that the sample sizes are very small in the extremely high HdL group, making the data unreliable. Alcohol and liver disease can cause high hdls so perhaps those people were driving the mortality. Studies on patients with genetic causes of high HDL (cetp deficiency, etc) suggest they live a normal lifespan. Also, I don’t appreciate a plausible mechanism for high HDL alone to be dangerous
2). Your other parameters are good. Non HDL, Non LDL (= TC-HDL-LDL) cholesterol of 14 along with low triglycerides suggests low VLDL, IDL and remnants. LDL 67 which is fine but some people argue that even lower is better (particularly if it only requires low intensity meds). I’m sure you’ve read about dysfunctional HDL but you would expect evidence of dysfunctional lipid metabolism with elevated trigs, vldl, etc if that were the case.
3). Caution with the calcium scan as it may not reflect your current risk for plaque progression but instead plaque accumulation in the past. Your trigs in 2023 were elevated but not anymore.
4) There are no reasonable therapies to lower HDL so I’m not sure you can change it anyway. The one thing on your lipid profile that could be changed is LDL

Thanks so much!!

Lots of strength training and a bit of a pickleball addiction kind of keeps me shredded…

Plus no junk food and don’t drink my calories.

That's a big relief! I got one right before I turned 30 as a baseline measurement because I have a family history of CAD. My dad likely had blockages starting in his mid 30s that went undiscovered until some big ole heart attacks into his 40s and 50s. A calcium score of 0 is great news.