Harvard Heart Letter

HDL cholesterol: Is higher really better?

Raising HDL with niacin takes a back seat to lowering LDL with statins.

Doctors often encourage people with heart disease or at risk for it to attain high-density lipoprotein (HDL) cholesterol levels above 40 milligrams per deciliter (mg/dL). Levels lower than that, the thinking goes, diminish this "good" cholesterol's power to protect the heart and arteries. But the importance of raising HDL may be declining, especially for people with rock-bottom levels of low-density lipoprotein (LDL) cholesterol.

How HDL does a body good is less well understood than how LDL performs its mischief. We do know that HDL is a multitasker. It removes cholesterol from the arteries and returns it to the liver for disposal. It prevents oxygen from turbocharging LDL cholesterol into an even more harmful artery-clogging substance. It eases inflammation, a contributor to plaque development. It also reduces levels of fibrinogen, a key player in the formation of the blood clots that trigger heart attacks and most strokes.

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