The story you didn't know about good cholesterol (HDL): Isn't higher always better?

Most of us are a little scared when we hear the word cholesterol, right? But you probably know that there are two types of cholesterol: 'good' and 'bad'. We all think that this 'good cholesterol', that is, the type called HDL, is good for our bodies no matter how high it is. But is that really the case? Today we are talking about the fact that too much of this good cholesterol can sometimes be a problem.

Why do we call HDL 'good cholesterol'?

Simply put, cholesterol is a waxy substance found in our blood. There are two main types of it.

1. LDL (Low-Density Lipoprotein): This is the 'bad' cholesterol . When it builds up, it can build up in our blood vessels, clogging them, and over time, can cause serious diseases like heart attacks and strokes.

2. HDL (High-Density Lipoprotein): This is our speaker, the 'good' cholesterol . The main job of HDL is to pick up unwanted bad cholesterol (LDL) from all over the body and carry it to the liver. The liver breaks it down and removes it from the body as waste.

Think of our blood vessels as a system of pipes that carry water. LDL is like the dirt that gets stuck in those pipes. Then HDL is like the person who removes that dirt and cleans the pipes. That's why we call HDL 'good' cholesterol. When you go to a doctor and have your cholesterol checked and a `Lipid Panel` (some people also call it `Lipid Profile`) report is done, both LDL and HDL levels are shown in it.

Generally considered healthy levels are:

• For men: HDL level greater than 40 mg/dL.
• For women: HDL level greater than 50 mg/dL.

It is said that maintaining these levels can reduce the risk of heart disease and stroke.

Is it really dangerous to have high levels of good cholesterol?

You might think, "Too much of a good thing is good." But when it comes to HDL cholesterol, the story is a bit more complicated. New research has found that having high HDL levels may not provide the expected protection. In some cases, this good cholesterol can start to behave like bad cholesterol, increasing the risk of heart disease.

Another study found that people with very high HDL levels (above 80 mg/dL in men and above 100 mg/dL in women) had a higher risk of death. It also found that in older people, HDL levels above 80 mg/dL increased the risk of dementia by 27%.

So why is this happening?

Although the reason for this is not 100% clear, researchers have some ideas. When our bodies are in a state of inflammation, these HDL particles can change their function. Instead of removing bad cholesterol (LDL), they help slow down the process. This can lead to increased LDL deposits (plaques) in the blood vessels, which can increase the risk of heart attack and stroke.

What are the causes of high HDL levels?

There are several reasons why HDL levels can be higher than 60 mg/dL. Some of these are within our control, while others are beyond our control.

1. Genetic influence (Your Genes)

Some people are born with a genetic predisposition to have high HDL levels. While this may sometimes provide protection against heart disease, certain genetic mutations (such as the `SCARB1` gene) can also increase the risk of heart disease by causing these high HDL levels. If someone in your family, such as your mother, father, or siblings, has heart disease and your HDL levels are also high, it is important to tell your doctor.

2. Your Diet

Foods high in unsaturated fats, such as fish, nuts like cashews, and green vegetables, can help raise HDL levels. However, foods high in saturated fats can raise both bad cholesterol (LDL) and good cholesterol (HDL) levels unnecessarily .

Some foods high in saturated fat:

• Red meat
• Cream and full-fat dairy
• Butter, Cheese
• Bakery products such as cakes and biscuits
• Fried foods

3. Excessive alcohol consumption

Drinking alcohol can raise HDL levels. In moderation , it can sometimes be beneficial. However, drinking more than two drinks a day can raise HDL levels to unhealthy levels and increase LDL levels. This can increase the risk of high blood pressure, stroke, and heart disease.

4. Some medications

Some medications you take can also increase your HDL levels.

• Cholesterol-lowering drugs (statin drugs)
• Birth control pills
• Hormone replacement therapy for menopause
• Medicines for diseases such as epilepsy (seizures)
• Types of steroids (Corticosteroids)
• Insulin

5. Menopause

After menopause, women's estrogen levels decrease. This hormone helps to raise HDL levels and protect the heart. When estrogen levels decrease, HDL levels may remain the same, but its protective properties may decrease.

6. Thyroid Problems

Hypothyroidism can cause both LDL and HDL cholesterol levels to increase.

How to treat high HDL levels?

Okay, now you're probably thinking, "Oh, what if my HDL level is high too?" Don't worry. If you don't have any other symptoms or risk factors for heart disease, you may not need any special treatment for high HDL levels.

Your doctor will first determine the cause of your high cholesterol. Only then will they decide whether treatment is necessary. Typically, when treating cholesterol, the main goal is to lower your bad cholesterol (LDL) levels.

There are no specific medications approved to lower HDL levels. However, you can help control your HDL levels by reducing alcohol consumption and adopting a low-fat diet .

How often should you get your cholesterol checked?

This depends on your age, health status, and family medical history. General recommendations are in the table below.