Is my cholesterol level dangerous?
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Understanding the Risks of Cholesterol Levels
Low High-Density Lipoprotein Cholesterol (HDL-C) and Coronary Heart Disease Risk
Isolated Low HDL-C in Asian Populations
Research indicates that isolated low levels of high-density lipoprotein cholesterol (HDL-C) are significantly associated with an increased risk of coronary heart disease (CHD), particularly in Asian populations. A meta-analysis involving 220,060 participants from the Asia-Pacific region found that low HDL-C levels were more prevalent among Asians compared to non-Asians, with 22.4% of Asians exhibiting isolated low HDL-C versus 14.5% of non-Asians. This condition was linked to a higher risk of CHD, with a hazard ratio of 1.67 for isolated low HDL-C.
Primary Low HDL-C and Cardiovascular Disease
A study from the Multi-Ethnic Study of Atherosclerosis (MESA) also supports the association between low HDL-C and increased cardiovascular risk. Participants with primary low HDL-C had higher risks of CHD and cardiovascular disease (CVD) compared to those with optimal lipid profiles, with hazard ratios of 2.25 and 1.93, respectively.
High Cholesterol Levels and Cardiovascular Mortality
Total Cholesterol and LDL-C
A systematic review and meta-analysis of prospective cohort studies revealed that high levels of total cholesterol and low-density lipoprotein cholesterol (LDL-C) are associated with increased cardiovascular mortality. The pooled hazard ratios were 1.27 for total cholesterol and 1.21 for LDL-C, indicating a clear link between elevated cholesterol levels and higher risk of cardiovascular death.
Extremely High HDL-C Levels
Interestingly, extremely high levels of HDL-C, often considered "good cholesterol," have also been associated with adverse outcomes. A meta-analysis of 17 cohort studies found that extremely high HDL-C levels were linked to increased risks of all-cause mortality, CVD mortality, and stroke, with relative risks of 1.15, 1.14, and 1.14, respectively. Another study confirmed that extremely high HDL-C levels were associated with higher risks of cardiovascular mortality, particularly in current drinkers.
Cholesterol Levels in Diabetic Populations
Metabolic Dyslipidemia in Diabetes
In individuals with diabetes, the presence of metabolic dyslipidemia (high triglycerides and low HDL-C) significantly increases the risk of CHD, even when LDL-C levels are below 100 mg/dL. A study involving 28,318 adults with diabetes found that those with metabolic dyslipidemia had higher age-adjusted CHD event rates and increased hazard ratios for CHD compared to those with normal HDL and triglyceride levels.
Conclusion
Both low and extremely high levels of HDL-C are associated with increased cardiovascular risks. While low HDL-C is a well-established risk factor for CHD, particularly in Asian populations, extremely high HDL-C levels also pose significant risks for all-cause and cardiovascular mortality. Additionally, individuals with diabetes and metabolic dyslipidemia face heightened CHD risks, underscoring the importance of comprehensive lipid management in these populations. Regular monitoring and appropriate interventions are crucial to mitigate these risks and improve cardiovascular outcomes.
Sources and full results
Most relevant research papers on this topic
Isolated Low Levels of High-Density Lipoprotein Cholesterol Are Associated With an Increased Risk of Coronary Heart Disease: An Individual Participant Data Meta-Analysis of 23 Studies in the Asia-Pacific Region
Primary Low Level of High-Density Lipoprotein Cholesterol and Risks of Coronary Heart Disease, Cardiovascular Disease, and Death: Results From the Multi-Ethnic Study of Atherosclerosis.
Serum Cholesterol Levels and Risk of Cardiovascular Death: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies
Association between extremely high-density lipoprotein cholesterol and adverse cardiovascular outcomes: a systematic review and meta-analysis
Metabolic Dyslipidemia and Risk of Coronary Heart Disease in 28,318 Adults With Diabetes Mellitus and Low-Density Lipoprotein Cholesterol <100 mg/dl.
Repeated measures of extremely high levels of high-density lipoprotein cholesterol and subsequent all-cause mortality and cardiovascular events: A longitudinal study.
Non-high-density lipoprotein cholesterol and risk of cardiovascular disease in the general population and patients with type 2 diabetes: A systematic review and meta-analysis.
Association of extremely high levels of high-density lipoprotein cholesterol with cardiovascular mortality in a pooled analysis of 9 cohort studies including 43,407 individuals: The EPOCH-JAPAN study.
Association Between High-Density Lipoprotein Cholesterol Levels and Adverse Cardiovascular Outcomes in High-risk Populations.
Lipoproteins, cholesterol homeostasis and cardiac health
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