High-density lipoproteins (HDL) are molecules that transport fat through the body and to the liver so that it can be processed.
This helps to prevent excess accumulation, which is why it is also referred to as “good cholesterol.”
High levels of HDL cholesterol have always been considered to be protective for heart health.
Now, researchers at the University of Pittsburgh Graduate School of Public Health in Pennsylvania — in collaboration with colleagues from other institutions — are questioning whether the ways in which we look at HDL cholesterol levels to predict cardiovascular risk may not be helpful for women.
“The results of our study,” says lead author Samar El Khoudary, “are particularly interesting to both the public and clinicians because total HDL cholesterol is still used to predict cardiovascular disease risk.”
Questioning the usefulness of looking at “good cholesterol” as protective for the heart, the team’s findings are published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology of the American Heart Association.
The scientists analyzed the medical data of 1,138 women, aged 45–84, recruited through the Multi-Ethnic Study of Atherosclerosis.
El Khoudary and team also considered the influence of women’s age at menopause and the time it took for women to transition to the postmenopausal period on HDL’s contribution to heart health.
The scientists found a link between high HDL cholesterol and increased risk of atherosclerosis, particularly among women who had a greater age at the time of menopause and those at least 10 years into the postmenopausal period.
However, the researchers also found that a higher concentration of total HDL particles indicated a lower risk of developing atherosclerosis among the study participants.
But the results get even more complicated: having a high number of small-sized HDL particles, El Koudary and team observed, seemed to have cardioprotective effects for all postmenopausal women, regardless of their age at menopause or how far into postmenopause they were.
Conversely, large-sized HDL particles indicated an increased risk of cardiovascular disease in the case of women who were close to menopause. This, the researchers explain, is likely due to the fact that at this time, the quality of HDL is affected.
“Identifying the proper method to measure active ‘good’ HDL is critical to understanding the true cardiovascular health of these women,” notes senior study author Dr. Matthew Budoff.
El Khoudary explains, “This study confirms our previous work on a different group of women and suggests that clinicians need to take a closer look at the type of HDL in middle-aged and older women, because higher HDL cholesterol may not always be as protective in postmenopausal women as we once thought.” “High total HDL cholesterol in postmenopausal women could mask a significant heart disease risk that we still need to understand.” Samar El Khoudary