Can high HDL (Good Cholesterol) actually be dangerous?

I made a startling discovery in the previous month, and so I thought I'd throw this out there in case anyone can benefit and/or just has an interest. I had two relatively minor strokes last month and was hospitalized for several days. Please understand that I am not suggesting you can draw any definitive conclusions from the info I am providing here. There is a need for much more research. So please draw you own conclusions.

I went to the ER twice over a two week period last month, because they did not find the problem until the second visit. The symptoms initially were some very mild numbness on my right-side. Then on the second occasion I was watching TV and suddenly could not see the entire screen. So I got up and went into the bathroom. When I looked in the mirror, I was unable to see the right-side of my face. Regardless which eye I covered, the right-side of my face was not visible. However, eventually the symptoms began to subside, and so I just figured I was having an ocular migraine. I was extremely tired, so I decided to go to bed. I now realize what a mistake that was and feel very foolish for doing so. When I woke in the morning (and I was damn lucky that I awoke in the morning), I was still having some vision problems. So I headed to the ER again. I should note that prior to the strokes, my HDL (good cholesterol) was in the 90's (mg/dl) and my total cholesterol was at the top of the normal range (180 -205 mg/dl). My cardiologist had always told me that although my total cholesterol was at the high end of the range, he had no concern with it, because my HDL (good cholesterol) was so high. Although my weight was not always ideal, I was never significantly over-weight and always got plenty of exercise. My diet was fairly healthy and included a significant amount of healthy fats from foods like salmon, olive oil, and a very minimal amount of unhealthy fats. I was eating salmon 3-4 times per week and always believed that keeping my HDL high was the answer to preventing stroke/heart attack. Besides, I just loved salmon and a good salad! All of the literature and my Docs always seemed to validate that with HDL; "the higher the better". That was validated in my research, because I was unable to find an upper-limit for HDL-C published in the guidance. That is just conventional wisdom, right?

So when I had the stroke symptoms, they administered a CT scan in the ER. I was unable to get an MRI due to my old PM leads! Turns-out; my veins and arteries were in-fact almost completely clear. There was hardly any plaque at all. The resident cardiologist at the hospital told me that; given my age and having just had a stroke, he was amazed at how clear they were. That is, with one exception; my left carotid artery. It had a 60% blockage (build-up of plaque) while the right carotid was completely clear (0% blockage). Although the thing is, the blockage in the left was only on one side of the artery wall as opposed to being spread evenly on both sides. Additionally; there was ulceration on the surface of the plaque that made it especially dangerous. In-fact; that is what was breaking-off and causing the stroke symptoms. So to get to the point; I underwent a carotid endarterectomy. I had that artery cleaned out. They normally would not perform a carotid endarterectomy with less than 80% blockage, but the unusual characteristics and circumstances surrounding mine dictated it.  The surgeon told me that the plaque she removed was the weirdest she's seen. I don't know if she meant that literally or not, but certainly the point was that it was not normal plaque. The consistency was crumbly at the artery wall and like toothpaste at the surface.

The bottom line is; that I had a lot of questions. So I started doing research. Turns-out that recent research has indicated that when HDL is too high (above 60-70, mine was 93 after the stroke); it is just as dangerous as LDL that is too high. The reason is; the plaque, although there is much less with high HDL, is a dangerous consistency that as such, is much more likely to break-off and cause a stroke or heart attack. The literature that I found, characterizes the plaque from excessively high HDL as being hard and crumbly. That matches the same characterization that the vascular surgeon gave my plaque. So the optimal range for HDL (good cholesterol) is now suggested (in only a few references I could find) to be 40 mg/dl to 60 mg/dl. The old theory that "the higher the better" for HDL-C seems to be going out the window. There needs to be more research, but it seems that the old theory may no longer be valid. It actually may be dangerous as I discovered. I corresponded with Nathalie Pamir, Ph.D., a senior author of the most recent study (I included a link below) and an associate professor of medicine within the Knight Cardiovascular Institute at Oregon Health & Science University, Portland. She indicated that she is high risk due to her high HDL-C and indicated that additional studies are urgently needed.

A late edit: I also should have mentioned that I also discovered that high HDL is often inherited (genetic). Obviously, if it is, It can be increased further (made worse) by diet.

Here are a couple links relative to what I discovered:

https://www.uspharmacist.com/article/common-otc-drugs-supplements-potentially-can-confound-laboratory-results-1-1

https://www.cnn.com/2022/11/21/health/hdl-cholesterol-study/index.html

https://www.nih.gov/news-events/news-releases/study-challenges-good-cholesterol-s-role-universally-predicting-heart-disease-risk

12 Comments

high cholesterol

by new to pace.... - 2022-12-15 12:47:25

Sorry to hear of your minor strokes thanks for this important information.  I will check my good cholesterol.  I know my carotids   are at 45%.

new to pace

Too much of a good thing?

by Gemita - 2022-12-15 18:00:30

Hello Dave, thank you for taking the time to tell us about this new finding that higher than normal levels of HDL may not be as beneficial as we once thought.  There is no doubt that having too much of a good thing is not always healthy and adopting a one size fits all approach is never a wise policy.  

I found the links very helpful and certainly more research needs to be done.  I note from the last link, we need to assess the quality of HDL’s function in picking up and transporting excess cholesterol from the body which may be more important for supporting cardiovascular health than worrying about the quantity of cholesterol present.

How will this early news affect the medication that we are given to control cholesterol I wonder?  I see that although Statins quickly reduce LDL, the bad cholesterol by 50% or more, Statins also boost HDL, the good cholesterol by up to 15%, so if our levels of HDL are already high, we could end up pushing them even higher by taking a Statin to control our bad cholesterol.  This would make it more urgent than ever to carry out further research before handing out Statins.

How are you now Dave?  Are you fully recovered from your minor strokes and after your carotid endarterectomy?  I hope you are being well looked after by your doctors and they are helping you to understand why this has happened when your arteries are so clean elsewhere. Are you taking a Statin or have any of your meds changed?

Good Dog

by MinimeJer05 - 2022-12-15 18:42:57

Dave,

While I don't have much to offer in regards to the topic of the conversation, I just wanted to stop in and say that I am sorry to hear about the strokes and that I hope you are recovering and doing well. I haven't been on the forums as much and missed your last post explaining the story.

I respect your optimisim and positivity and your abilty to take such a scary situation and learn from it, by posting this and really trying to understand more about it. That sounds like a terrifying event that you handled with ease.

I am glad to see you continuing to post, helping other members and educating us in the process.

Take care sir!

Jer

Thank you all

by Good Dog - 2022-12-15 20:59:35

I truly appreciate the caring and thoughtful comments from each of you! I am doing O.K., but dissapointed that I continue to have some minor vision problems. It is just close-up vision. My distance vision is fine. I had hoped my reading (close-up) vision would have improved more by now, but it has not. So I guess that I have to live with this. That seems to be the only significant issue remaining. I still have a little pain at the incission, but it is healing well. The dissolving stitches are great! I don't seem to have the same level of energy that I had before the stroke, but I figure that there could be any number of reasons for that. So I think that I am about 95% recovered. I am extremely grateful that the stroke has not had a significant negative impact on my ability to do anthing. I have a little trouble reading and typing, but other than that, nothing much to complain about. What I find interesting is that when I try to type rapidly, the typo's are always the same. I hit accidently the key directly to the left of the one I intended to hit. What with the stroke on the left-side of the brain, it impacts the functioning on right-side of the body. When the stroke first occurred, I could not see things on the right-side. I am thinking that maybe my brain is now shifting things to the left. So perhaps that is why I have a tendency to hit the key to the left? Who knows? I'll likely never know. The brain is mysterious. At least it is to me! As far as my medication goes, I see my new cardiologist in two weeks and plan to have a heart to heart discussion with him about where we go from here. I have eliminated HDL boosting foods from my diet (I hope only temporarily) and so it makes no sense to take statins that raise it. So I do not know yet what if any medication he will suggest, but whatever it is, it will only be with my input and approval. We'll see and I will let you know!

Gemita, I just want to thank you for the support you have provided me during and prior to this ordeal with my stroke. I believe that you are one of the greatest assets that this group has going for it. You are so generous with your time and have offered so much great advice, support, direction and kindness for so many people, it is just invaluable. It certainly has been for me! I think that we all often just want to know that there is someone out there that cares. You seem to always be there to offer that. So THANK YOU!

Sincerely,

Dave  

voice to type

by new to pace.... - 2022-12-15 21:11:54

You might look into using  your voice  to type,  as a way not to be concerned   about where the  letters..

new to pace

High HDL

by AgentX86 - 2022-12-15 21:46:58

Yes, I've known that.  I think I mentioned that here a month or so ago when someone was talking about their high "good cholesterol.  Too much of a good thing...

I had a CT-A on my carotids five or six years go.  It was a precaution after my CABG.  Blockages in the heart point to blockages otherwhere.  My CT-A showed >70% blockage in both carotids.  Was given the choice of the neck surgery or stenting.  I went with the senting but when they got the catheter in there, there was nothing there.  The blockage was less than 20%, so just packed up and left.  Evidently, my paque was calcium which is denser than cholesterol so showed as being much worse than it was.  The vascular surgeon wasn't too worried about the calcium because it was unlikely to break off and go anywhere.  I have a echo on it once a year (just had it a couple of weeks ago) just to make sure it's not getting worse.

Left carotid plaque

by Rch - 2022-12-16 02:36:15

Hi

I am glad you are doing better, But I have a question. With only the left carotid artery having the ulcerated plaque and the right being very clear, why were you having partial vision loss in both eyes? Did the Neurologist explain that to you?  Could the stroke be from a different artery other than the the left carotid artery? Just wondering!

Are you now on any antiplatelet agents? 

 

 

Rch - My vision

by Good Dog - 2022-12-16 07:15:59

Thank you for the kind words. I am sorry if I caused any confusion. I'll try to clear it up.

I did not have vision loss in both eyes. The problem is not really in my eyes, it is in my brain. Actually, the problem was that a piece of plaque broke-off from the left carodit and that piece of plaque traveled to the left part of the brain that controls vision and was lodged there, It blocked the blood-oxygen flow from that area until it eventually dissolved. That left-side of the brain comtrols functioning on the right-side of the body which is why my vision was impacted on the right-side. 

They did give me baby aspirin at the hospital which is an antiplatelet agent. They did so to prevent the possibility of a blood clot, but fortunately, that was/is not a problem. So I am not on any antiplatelet agents. 

Dave

Vision should hopefully improve Dave

by Gemita - 2022-12-16 07:21:32

Dear Dave,

I am lost for words, thank you.  It has been a pleasure to be in touch and to share information with you.  Each member brings something special to this Club and I find it extremely hard to ignore their posts and calls for help.

It is still very early days following your stroke.  I recall my husband had difficulty for quite some time until his sight settled following his last cerebellar stroke.  And your sight will hopefully improve given time although you may need professional help with your vision recovery.

My husband’s sight fluctuates too with his diabetes since higher blood glucose levels will affect his vision immediately, so might be worth letting your GP know what is happening and getting some additional checks just in case something else is making your vision worse too.

I hope you have a helpful meeting with your cardiologist in a few weeks time.  Please keep us updated

Thanks for the clarification

by Rch - 2022-12-16 14:27:31

I am glad you didn't experience any language or speech difficulties with the left sided event! Hope you will fully recover soon!

In awe

by Lavender - 2022-12-17 08:33:33

Dave-you're so wise and compassionate. After all you've gone through, you still seek help and answers and share that gained knowledge to benefit others. 🙌🏼

Glad to know you! 💚❤️

vision

by new to pace.... - 2022-12-17 08:48:51

You might try acpuncture for you vision.  Helped my friend to see a little after her eye stroke.  Also been helping me with my blurry vision and  my recent Stye.

New to pace

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