In the study, while low HDL cholesterol levels predicted an increased risk of heart attack and related death for white people, this was not the case for black people. In addition, high HDL-cholesterol levels do not appear to be protective: they were not associated with a reduced risk of cardiovascular disease in any of the groups.
“The goal was to understand this long-standing association of HDL being referred to as a beneficial cholesterol for people of all ethnicities. It is generally accepted that low HDL cholesterol levels are harmful. Our research has challenged these assumptions,” said Dr. Nathalie Pamir from Oregon Health & Science University in Portland.
To do this, the team evaluated data from 23,901 adults in the United States who had participated in the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS). Previous studies that shaped perceptions of “good” cholesterol were mostly white adult study participants in the 1970s. In the current study, the researchers examined how cholesterol levels in middle-aged black and white adults without heart disease were related to future cardiovascular events. This suggested a slightly increased risk of cardiovascular disease for adults with elevated levels of LDL cholesterol and triglycerides, consistent with previous research. However, it was observed for the first time that lower HDL-cholesterol levels predicted an increased risk of cardiovascular disease only in white adults, and high HDL-cholesterol levels did not necessarily protect against it.
Which: DOI 10.1016/j.jacc.2022.09.027