New Study Shows That ‘Good’ Cholesterol Just Got Better

HDL cholesterol levels are already used as part of standard heart health testing to help predict cardiovascular risk. By removing other forms of cholesterol from the blood HDL, cholesterol helps reduce the risk of heart disease. Recent research in the American Heart Association's top journal, Circulation, indicated that there is additional information HDL cholesterol can provide in predicting heart disease beyond quantity.

Atherosclerosis (plaque formation in the arteries) has been extensively studied as an underlying factor for heart disease. Research has identified that this plaque build-up has a strong inflammatory component. One of the key biological functions of HDL cholesterol is the reduction of inflammation.  

This property of HDL to reduce inflammation and plaque build-up led researchers to consider its clinical relevance in disease risk prediction. This new study is the first to evaluate if the anti-inflammatory function of HDL can protect against serious heart conditions.

Participants from a more extensive study of white adults (average age of 59, 70% male) living in the Netherlands were evaluated during this new study. Three hundred and forty adults who had experienced a first cardiovascular event (defined as a fatal or non-fatal heart attack, narrowed heart arteries, or surgery for clogged arteries) within the 10.5 years follow-up period were tested. 

Researchers performed lab tests to measure the anti-inflammatory capacity of HDL particles (ability to reduce inflammation in the endothelial cells), C-reactive protein levels (a protein that increases during the inflammatory response), and cholesterol efflux (an assessment of how efficiently HDL removes cholesterol). 

The results showed:

♦ HDL anti-inflammatory capacity was higher in individuals who remained healthy (31.6%) than those who had experienced a cardiovascular event (27%).

♦ There was no correlation between anti-inflammatory capacity and C-reactive protein levels or cholesterol efflux capacity.

♦ For every 22% increase in the ability of HDL particles to suppress endothelial inflammation, there was a 23% increased risk for a cardiovascular event within the next decade. 

♦ Adding anti-inflammatory capacity to the Framingham Risk Score improved cardiovascular event risk prediction.

The findings support the concept that arterial plaque formation has a relationship to inflammation. This means the properties of HDL are relevant to predicting the risk of heart disease. These results need to be confirmed among different populations, but this study is an important breakthrough in identifying risks for heart disease. 

HDL is a simple and established biomarker for cardiovascular disease, and this study shows that HDL can do even more. Its anti-inflammatory capacity provides additional clinical information beyond the static measurements currently used. One day, this anti-inflammatory ability can be added to risk assessments to improve screening standards and predictive ability. ‘Good’ cholesterol just got better.

Journal reference: 

Jia, C., Anderson, J. L. C., Gruppen, E. G., Lei, Y., Bakker, S. J. L., Dullaart, R. P., & Tietge, U. J. F. High-Density Lipoprotein Anti-Inflammatory Capacity and Incident Cardiovascular Events. Circulation, 2021; DOI: 10.1161/CIRCULATIONAHA.120.050808