Most of the time, you want your cholesterol to be low—ideally less than 150 milligrams per deciliter (mg/dL). But as you likely know if you’ve had your levels tested, the results aren’t quite that simple.
Cholesterol tests will tell you not just your total cholesterol, but also your low-density lipoprotein, triglycerides, and high-density lipoprotein. And you actually want your high-density lipoprotein, or HDL, to be high.
HDL cholesterol is considered “good” cholesterol. While still a type of fat in your bloodstream, it doesn’t clog arteries, and higher levels are linked to lower chances of heart problems. Low-density lipoprotein, or LDL, is considered “bad” cholesterol because it’s the type that builds up in your arteries and can contribute to your risk for heart disease and stroke. Triglycerides, another type of fat in the blood, are tied to higher risks of heart attack and stroke if you also have low HDL or high LDL.
It would make sense, then, that in order to protect your heart, you’d want to boost your good cholesterol, or HDL. But research examining increases in HDL so far hasn’t shown any subsequent reduction in heart problems, and medications that raise your good cholesterol don’t stave off those risks, either.
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“Starting from the 1970s, large population studies…showed that people who had very low levels of HDL cholesterol…had a higher risk of heart attacks,” says Dr. Anand Rohatgi, an academic cardiologist and professor of medicine in cardiology at UT Southwestern Medical Center. It’s a “powerful risk predictor,” he says, which is why low HDL made it into the heart disease risk calculators doctors still use today—but it doesn’t necessarily translate to a treatment tactic. Experts agree that the relationship between higher HDL levels and better heart health is correlational—not causative. “The challenge has been that when drugs have been studied that raise HDL…
