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

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body fat percentages ranging from 7-9%.

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He’s submitted me for a calcium cardiac scan which is scheduled for early June.

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That won't tell you anything. Ask for a Cleerly scan instead.

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.

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I think the role of cholesteral in CVD is overblown.From my reading and experience in ICU the biggest drivers of CVD is inflammation,smoking,diabetes and unfortunate inheritance of the lipoprotein (a) gene.

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Nice post.
The more and more I read about heart disease, the more I see your points.

We have known for DECADES that smoking is bad for the body, yet millions still smoke those 'coffin nails.' Smoking causes the arteries to dilate and makes the blood become sticky. Not to mention the damage it does to the lungs.

Diabetes ravages the entire body, but the US has millions of folks that are diabetic. Most diabetes can be avoided by eating good healthy food, limiting sugar and keeping a healthy weight along with some exercise.

Heck, most people don't even know that our bodies produce cholesterol and cannot function without cholesterol.

To take it even further, the human brain is made of about 25% cholesterol. Is there are link between statins(which reduce cholesterol) and dementia? IDK

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I took care of a surprising number of pts.with stents or bypass surgery with normal total cholesteral levels,like in the 160’s range.

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I read a lot of world renowned cardiologist, Dr. Arthur Agaston(of South Beach Diet fame & co-creator of the Cardiac Calcium Score ) works.
He states much of what you say.

But as the saying goes, follow the money.
More $$$ is made by performing by-pass surgery, coronary angioplasty...rather than medical doctors pushing aggressive preventative measures to their patients and early testing such as advanced lipid testing and the new Cleerly Heart Scan procedure.

No, I wasn’t put on anything. I saw a different doctor in the practice in 2023 and he didn’t think anything of it.

It was only earlier this year that my regular doctor saw the results from ~18 months earlier and became concerned.

Prior to the calcium score results, he mention that he might want to put me n statins to reduce total cholesterol, even though my LDL is low.