Is Too Much HDL Cholesterol Bad for You?

Philosophers, poets and songwriters have long cautioned that too much of a good thing may bring harm. For some individuals, that warning applies to "good" cholesterol. A new study, published in Arterioscerolsis, Thrombosis, and Vascular Biology, found that a high level of HDL cholesterol--long thought to be cardio protective--places some patients at high risk for recurrent coronary events, such as chest pain, heart attack and death.

"It seems counterintuitive that increasing good cholesterol leads to negative consequences in some people," said James Corsetti, M.D., Ph.D., professor of Pathology and Laboratory Medicine at the University of Rochester Medical Center and lead author of the study. But in fact, that's exactly what his study found.

Corsettis team identified individuals at high risk for recurrent coronary events among 767 non-diabetic patients who experienced at least one prior heart attack. Patients in the high-risk subgroup--about 20 percent of the total study population-- were characterized as having high levels of C-reactive protein (CRP), a well-known marker of inflammation, in addition to high HDL cholesterol.

The researchers believe genetics and environmental factors, particularly inflammation, influence whether high levels of HDL cholesterol are protective or if they increase cardiovascular risk in individual patients. Given an inflammatory environment, an individuals unique set of genes helps determine whether HDL cholesterol is in a fact good or bad in the fight against heart disease.

Our research is oriented around the ability to better identify patients at high risk, said Corsetti. Identifying these patients and determining what puts them at high risk may be useful in choosing treatments tailored to the specific needs of particular patient subgroups. This gets us another step closer to achieving the goal of personalized medicine.

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