HDL Cholesterol: The Untold Story

By Michael Stanclift, ND

Since the 1950s we’ve associated HDL cholesterol with being a positive for our health, and to a large extent, that’s true.1-6 However, more recent studies show us that elevated HDL cholesterol can actually be cause for concern.7,8 So what do we think is going on here? Well, first we have to look at what we’re actually measuring when we look at HDL and why we have assumed that was protective for our cardiovascular systems.
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For years I taught patients that they can remember the “H” in HDL means that’s the “healthy” cholesterol. While this is mostly a good rule of thumb, the HDL letters actually stand for high-density lipoproteins. High-density lipoproteins are like tiny little garbage trucks that take excess cholesterol out of our system so we can get rid of what we don’t need. And when we measure HDL cholesterol, we’re basically looking at how much “garbage” (cholesterol) is inside those little trucks.

It would make sense that the more garbage we find, the more we would assume the trucks are picking up. Unfortunately, this is making a lot of assumptions based on just one finding. We’re assuming that we have enough garbage trucks, that everything on them is working, and that they’ll be dumping that garbage as soon as they get to the landfill (our livers). As you might suspect, those aren’t always the case. Sometimes our HDL particles contain a lot of cholesterol because there are just not that many little garbage trucks to handle all the cholesterol that needs to be transferred.9 Our HDL garbage trucks may also be loaded with cholesterol because they just aren’t unloading it well, which is akin to them driving around full and not picking up more garbage—not useful.10

So what we really want to know when we look at HDL and use that to predict cardiovascular health, is how much healthy HDL function does the patient have? This has been a tricky measure to pin down, but researchers and laboratories are looking to create tests that will give us a clear indication of healthy HDL function and bring that to us as patients. There are a few advanced tests available that can help give indications of our HDL function, but they still need more refinement.9
You’re probably thinking, “Are there ideal HDL levels? When should I seek more investigation?” We do have some indications of ideal levels that suggest our HDL is likely functioning well.  

​One study found the following ideal HDL ranges:9

• Men: 54-77 mg/dL
• Women: 69-97 mg/dL

If your HDL levels fall within these ranges, it’s likely functioning as it should, protecting your cardiovascular system and cleaning up other various things your body no longer needs.9 These ranges show us that there is likely an upper limit to what is healthy and ideal and that we might need to rethink the “more is always better” axiom we’ve followed for decades.

References:
1. Barr DP et al. Am J Med. 1951;11(4):480-493.
2. Gordon T et al. Am J Med. 1977;62(5):707-714.
3. Castelli WP et al. JAMA. 1986;256(20):2835-2838.
4. Cullen P et al. Circulation. 1997;96(7):2128-2136.
5. Sharrett AR et al. Circulation. 2001;104(10):1108-1113.
6. Di Angelantonio E et al. JAMA. 2009;302(18):1993-2000
7. Madsen CM et al. Eur Heart J. 2017;38:2478-2486
8. Hamer M et al. Arterioscler Thromb Vasc Biol. 2018;38(3):669-672.
9. Khera AV et al. Circulation. 2017;135(25):2494-2504.
10. Hancock-Cerutti W et al. Molecules. 2021;26(22):6862.