'Good' Cholesterol is Not One Thing But Many Distinct Things, Not All of Them Good—Jeremy Furtado
High-density-;ipoprotein (HDL) cholesterol is often called ‘good cholesterol’ because in the cross-section higher levels predict better cardiovascular outcomes. But so far drugs that raise HDL cholesterol have not improved cardiovascular outcomes. The interview with Jeremy Furtado shown above, “Why ‘good’ cholesterol may not always be good,” explains why: there are many subtypes of HDL cholesterol, some good, some bad. Unfortunately, so far the drugs known to raise overall HDL cholesterol raise the bad subtypes at least as much as the good.
The growing understanding that there are many different subtypes of HDL cholesterol that predict cardiovascular health differently is very hopeful. It should make it easier to identify drugs that will really help. It should also make for better cholesterol screening.
Subtypes are important for ‘bad’ low-density-lipoprotein (LDL) cholesterol as well. As we understand these subtypes better, claims that particular diets are bad because they raise LDL cholesterol will have to be modified according to which subtypes are affected.
The subtypes of LDL cholesterol have another implication which will be of great practical value to many of you: assuming you have enough money that you are not totally in thrall to what insurance will pay for, if your doctor says you have high LDL cholesterol, your next move should not be to take a pill or to follow the conventional wisdom of reducing consumption of saturated fat. Rather your next move should be to get a more advanced cholesterol test. I write of my experience with that in “You Might Need to Educate Your Doctor about the Effects of a Long Fast on Cholesterol Readings.” See also “Standard Cholesterol Tests are Substandard; Better Cholesterol Tests are Available” and “What is the Evidence on Dietary Fat?”
It is good to see our understanding of cholesterol move past the dark ages.
For annotated links to other posts on diet and health, see: