A major new research project questions the link between high density lipoprotein – the so-called “good cholesterol” – and reduced cardiovascular risk.
The project, backed by the US National Institutes of Health, suggests that race may be a key factor in the benefits of HDL.
In the US, Black Americans have a lower risk of overall heart disease, though a increased risk of fatal heart events.
To investigate why heart risk equations based on plasma lipids underperform in black adults, Dr Nathalie Pamir of Oregon Health & Science University, Portland, USA, and colleagues examined a large national database.
The REGARDS (REasons for Geographic and Racial Differences in Stroke) study includes 30,239 Black and White adults aged 45 years or below, recruited from 2003 to 2007.
Over the next ten years, the rate of heart events was linked to low-density lipoprotein cholesterol and triglycerides in both groups, the team report in *Journal of the American College of Cardiology* on Monday.
Low high-density lipoprotein cholesterol was significantly linked to increased heart risk in white participants only, with no link seen in black participants.
High HDL cholesterol was not linked to decreased heart events in either group, despite a long-standing belief in its protective effects.
The authors conclude: "Current high-density lipoprotein cholesterol–based risk calculations could lead to inaccurate risk assessment in black adults."
Dr Pamir said: “The goal was to understand this long-established link that labels high-density lipoprotein as the beneficial cholesterol, and if that’s true for all ethnicities.
“It’s been well accepted that low high-density lipoprotein cholesterol levels are detrimental, regardless of race.
“What I hope this type of research establishes is the need to revisit the risk-predicting algorithm for cardiovascular disease. A deeper dive into the epidemiology of lipid metabolism is warranted, especially in terms of how race may modify or mediate these relationships.”
Zakai, N. A. Race-dependent association of high-density lipoprotein cholesterol levels with incident coronary artery disease. *Journal of the American College of Cardiology* 21 November 2022
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