Link between cholesterol and heart disease varies across ethnicities

It turns out that the widely held concept that levels of “good” cholesterol in the blood can indicate risk of heart disease is not strictly true, at least not equally true in cases of blacks and whites, but also the measurement itself may be less valuable than previously thought, according to a new US study.

Various types of cholesterol are believed to have either healthy or harmful effects.

Low levels of so-called high-density lipoprotein (HDL) “good” cholesterol were associated with greater odds of developing heart problems in the long-term study — but only in white participants, the study published in the Journal of the American College of Cardiology found.

Contrary to what is generally assumed, low levels of HDL do not confer an increased risk of heart disease in black people, the researchers said. Among whites, however, those with HDL levels below 40 milligrams per deciliter had a 22% greater risk of coronary heart disease compared with those whose HDL levels were higher.

High levels of HDL — above 60 mg/dL — which are thought to be protective, were not associated with lower risks of coronary heart disease in any of the races, the researchers found.

“Typically, in the doctor’s office, those of us with higher levels of HDL are given a pat on the back” for being at lower risk, said study leader Nathalie Pamir of Oregon Health & Science University in Portland. “Now, instead of patting people with high HDL on the back, doctors should do nothing or say, ‘We don’t know what that means.’

High levels of “bad” low-density lipoprotein (LDL) cholesterol, typically treated with widely used statins such as Lipitor, and triglycerides were associated with increased risks of heart disease in both races, his team found.

The study, funded by the National Institutes of Health, collected data over approximately 10 years from nearly 24,000 American adults, about 42% of whom were black. Participants of both races were similar in age, cholesterol levels and other risk factors for heart disease, the researchers said.

The first studies that shaped perceptions about healthy cholesterol levels predominantly involved white American participants, Pamir said. “Our study puts a big question mark over the available biomarkers that we use to assess risk because they were developed without having all races in mind.”

The Doctor. Keith Ferdinand of Tulane University in New Orleans, who was not involved in the research, warned in an editorial that using HDL cholesterol levels to estimate risk “could inaccurately assess and possibly misclassify (coronary artery disease) risk in black adults and become a risk barrier to optimal care.”

Better estimates can be obtained, Ferdinand wrote, by measuring the amount of calcium accumulated in patients’ arteries and monitoring their levels of a form of cholesterol called Lp(a).

In all cases, he added, regardless of biomarker levels, “therapeutic lifestyle changes are the mainstay of prevention.”

Sabah Daily Bulletin

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Link between cholesterol and heart disease varies across ethnicities

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