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Black or White? Good cholesterol is not good for all: Study

Instead of relying on supplements, American Heart Association lays stress on a heart-healthy lifestyle

By Kiran N. Kumar

Elevated “bad” cholesterol or low-density lipoprotein (LDL) had been attributed to 4.51 million deaths in 2020, a 19% increase from 2010, according to American Heart Association 2022 statistics.

On the contrary, the popular perception is that lower levels of High-density lipoprotein (HDL) cholesterol or known as the “good” cholesterol is associated with increased risks for heart attacks.

But a new study has found low HDL was associated with increased cardiovascular disease risk in Whites but not Black adults, and high HDL was not protective in either group.

Read: South Asians are at four times greater risk of heart disease (December 24, 2021)

Of the two types, HDL or good cholesterol is believed to protect the heart while high levels of LDL or the “bad” cholesterol has been cited in many studies as a high risk factor for heart disease and stroke because it forms deposits that can narrow and stiffen arteries.

“The goal was to understand this long-established link that labels HDL as the beneficial cholesterol, and if that’s true for all ethnicities,” said author of the study Nathalie Pamir, who is associate professor of medicine at Oregon Health and Science University, Portland. “It’s been well accepted that low HDL cholesterol levels are detrimental, regardless of race. Our research tested those assumptions.”

Since most of the studies conducted during the 1970s were conducted on a majority of white adults, the study undertook a review of 23,901 adults who participated in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) between 2003-2007 and found that lower HDL cholesterol levels only predicted increased cardiovascular disease risk for white adults.

Will the good cholesterol pitch wane?
The other finding of the same study was that high HDL cholesterol levels are not always associated with reduced cardiovascular events, irrespective of white or black patients.

The REGARDS analysis was the largest US study to show that higher than optimal amounts of “good” cholesterol may not provide cardiovascular benefits for either group.

“What I hope this type of research establishes is the need to revisit the risk-predicting algorithm for cardiovascular disease,” Pamir said. “It could mean that in the future we don’t get a pat on the back from our doctors for having higher HDL cholesterol levels.”

Read: ‘South Asians at four-times greater risk of heart disease’ (September 11, 2021)

The findings have left the researchers to explore several theories of the HDL or good cholesterol’s role in supporting heart health. One is quality over quantity — instead of insisting on more HDL, the quality of HDL’s function in picking up and transporting excess cholesterol from the body may be the key to support cardiovascular health.

Another possibility could be looking at properties of HDL cholesterol, including analyzing hundreds of proteins associated with transporting cholesterol and how one or a group of proteins may improve cardiovascular health predictions.

“HDL cholesterol has long been an enigmatic risk factor for cardiovascular disease,” explained Sean Coady, from the National Heart, Lung, and Blood Institute (NHLBI).

“The findings suggest that a deeper dive into the epidemiology of lipid metabolism is warranted, especially in terms of how race may modify or mediate these relationships.”

Until then, the cardiovascular disease risk calculators using HDL cholesterol could lead to inaccurate predictions for black adults, they warn. “When it comes to risk factors for heart disease, they cannot be limited to one race or ethnicity,” said Pamir. “They need to apply to everyone.”

Marketing good cholesterol?
Early this month, another study found that of six widely used dietary supplements promoted for improving heart health did not effectively lower LDL or “bad” cholesterol in comparison to a common low-dose statin medication or placebo.

Their study presented at the American Heart Association’s Scientific Sessions 2022 in Chicago revealed that there was no difference in total cholesterol measures for participants taking any of the six dietary supplements or those who did not. This brings into question the claimed benefits associated with these supplements.

In fact, Americans spend an estimated $50 billion on dietary supplements annually as per a 2020 market survey and often they are marketed for ‘heart protection’ or ‘cholesterol management’.

But “there is minimal-to-no research demonstrating these benefits,” said study author Luke J. Laffin, from the Cleveland Clinic in Ohio. “Some people also believe supplements are as effective or more effective than cholesterol-lowering statin medications.”

Read: Study suggests that HDL or ‘good’ cholesterol is less beneficial than previously thought, especially for Black adults (November 21, 2022)

This study compared the effectiveness of a low-dose statin to that of six common dietary supplements in lowering low-density lipoprotein (LDL) cholesterol – known as bad cholesterol – as well as their effects on other cholesterol levels and markers of inflammation.

Irrespective of these supplements or research findings, the American Heart Association in its 2018 Cholesterol Guidelines emphasizes one thing for all — a heart-healthy lifestyle throughout life — instead of relying on supplements. It recommends adequate nutrients by eating a variety of foods in moderation besides optimal physical activity.

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