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Started By
Message
Another Cholesterol Question with a twist
Posted on 5/13/25 at 12:24 pm
Posted on 5/13/25 at 12:24 pm
My PCP told me in my last visit that he’s concerned that I’m a cardiac ticking time bomb. I was pretty shocked.
He’s concerned that my HDL (good cholesterol) is extremely high, which some recent studies have shown can be very bad.
Here are my numbers from 18 months apart:
Late 2023:
Triglycerides: 104
LDL: 69
HDL: 109
Total Cholesterol: 197
Early 2025:
Triglycerides: 60
LDL: 67
HDL: 101
Total Cholesterol: 182
He’s submitted me for a calcium cardiac scan which is scheduled for early June.
FYI - I’m 62 years old, 5’7”, 135 lbs. I do strength training, pickleball and yoga and have a super healthy diet.
I’ve done InBody scans for 4 weeks straight to get a series of readings. It places me as a D-type body, with body fat percentages ranging from 7-9%.
I read the studies that he referenced, and they looked legit. I then read a study that countered both of those.
I’ve researched how to decrease HDL and I can’t find a single reference on how to do that.
Any thoughts/comments if there’s a real concern here?
He’s concerned that my HDL (good cholesterol) is extremely high, which some recent studies have shown can be very bad.
Here are my numbers from 18 months apart:
Late 2023:
Triglycerides: 104
LDL: 69
HDL: 109
Total Cholesterol: 197
Early 2025:
Triglycerides: 60
LDL: 67
HDL: 101
Total Cholesterol: 182
He’s submitted me for a calcium cardiac scan which is scheduled for early June.
FYI - I’m 62 years old, 5’7”, 135 lbs. I do strength training, pickleball and yoga and have a super healthy diet.
I’ve done InBody scans for 4 weeks straight to get a series of readings. It places me as a D-type body, with body fat percentages ranging from 7-9%.
I read the studies that he referenced, and they looked legit. I then read a study that countered both of those.
I’ve researched how to decrease HDL and I can’t find a single reference on how to do that.
Any thoughts/comments if there’s a real concern here?
This post was edited on 5/13/25 at 12:34 pm
3
Posted on 5/13/25 at 2:23 pm to Atttaboy
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.
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.
This post was edited on 5/13/25 at 2:25 pm
Posted on 5/13/25 at 2:52 pm to NewOrleansBlend
Thanks - I’ll give it a listen
Posted on 5/13/25 at 3:12 pm to Atttaboy
Sure. Post the studies they referenced if you have them, would like to read them.
Posted on 5/13/25 at 3:37 pm to NewOrleansBlend
Posted on 5/14/25 at 12:12 pm to Atttaboy
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
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
This post was edited on 5/14/25 at 1:51 pm
Posted on 5/14/25 at 4:01 pm to NewOrleansBlend
Thanks so much!!
Posted on 5/15/25 at 3:38 pm to Atttaboy
quote:
body fat percentages ranging from 7-9%.
quote:That won't tell you anything. Ask for a Cleerly scan instead.
He’s submitted me for a calcium cardiac scan which is scheduled for early June.
Posted on 5/16/25 at 9:52 am to Big Scrub TX
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.
Plus no junk food and don’t drink my calories.
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