Harvard Heart Letter

Heart Beat: HDL function, not just amount, could affect artery health

When it comes to protective high-density lipoprotein (HDL) cholesterol, the most important question has long been "How much do you have?" Numerous studies have shown that the more HDL you have in your bloodstream, the more protected you are from heart attack and the most common kind of stroke. The day may be coming, though, when "How powerful is your HDL?" is an equally important question.

We've known for some time that not all HDL is created equal. Some HDL is better at pulling cholesterol out of white blood cells called macrophages. Less cholesterol inside macrophages means less cholesterol deposited into artery-clogging plaque. Work from the University of Pennsylvania indicates that folks with more powerful HDL have less cholesterol-filled plaque in the coronary arteries nourishing the heart and the carotid arteries that nourish the brain (New England Journal of Medicine, Jan. 13, 2011).

At least for now, there isn't much you can do to make your HDL stronger. That could change — this work has almost certainly sparked one or more pharmaceutical companies to pour more money into research exploring what makes some HDL more powerful and how to nudge less powerful HDL in that direction.

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