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

April 01, 2006

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.

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