Harvard Heart Letter

Ask the doctor: Which is more important, high bad cholesterol or high good cholesterol?

Ask the doctor

Which is more important, high bad cholesterol or high good cholesterol?

Q. My doctor and I are confused by my cholesterol levels. My good cholesterol is extraordinarily high, at 94, but my bad cholesterol is on the high side, too, at 154. To resolve this good news/bad news story, my doctor ordered a C-reactive protein test which, of course, came back right in the middle of the normal range. I don't smoke or have other risk factors for heart disease. Would you advise me to start a statin or some other drug?

A. Let me start by asking your question another way: How do LDL and HDL intersect for gauging one's risk of heart disease and for guiding therapy? The answer, in a nutshell, is that a high HDL does not "cancel out" a high LDL.

The more low-density lipoprotein (LDL) in the bloodstream, the higher your chances of having a heart attack or stroke or developing other forms of cardiovascular disease. At the same time, the more high-density lipoprotein (HDL) you have, the lower your risk. This is why LDL is often called bad cholesterol and HDL is called good cholesterol. Lowering your LDL with a statin or other medication can lower your risk. So can raising your HDL, though this is harder to do.

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