HDL To The Rescue

Doug asked me another question. And since, although I know little about ear wax, I do know a little more about waxy substances in blood, I decided to post it.

Q.   "Got back my lab tests this week. My cholesterol is a great 120 (thanks to drugs) but my HDL isn't high enough, apparently. Do you know if it matters that my HDL:LDL ratio is off, since my cholesterol is so low?"

A.   I'm not a doctor, it's just my opinion, but...

I would say, yes, it matters that your LDL/HDL ratio is low. It is more indicative of CHD (coronary heart disease) than total cholesterol (TC) alone.

HDL is good stuff. Someone can have a higher TC than you, but if their HDL is also high, they may deposit less cholesterol in their arteries since one of HDL's tasks is to scavenge cholesterol and return it to the liver. (Another beneficial effect of HDL is to slow the oxidation of LDL. See my last paragraph.)

You said that your "HDL isn't high enough". HDL as an absolute number, that is, not relative to total cholesterol (TC) or other fractions (like LDL) doesn't give you the whole picture. If your HDL is, say, 40 mg/dl (lowish), but it makes up a third of your 120 mg/dl TC, that's mighty fine - certainly better than if it made up a quarter or less of a higher TC.

Generally, it's good to see:
TC/HDL: 4 or less
LDL/HDL: 3 or less

Women's HDL tends to be higher than men's, at least before menopause. And while some female hormones (e.g. estrogen) bump it up, some male hormones (e.g. testosterone) push it down. So do smoking (including 2nd hand smoke), insufficient aerobic exercise, and other hormones (e.g. anabolic steroids).

All that said, the concern of late seems to be, apart from how much cholesterol you have, whether it's undergoing oxidation. That's key! It's not simply LDL, but oxidized LDL that promotes atherosclerosis. And it's inflammation that promotes oxidation. Did they test your CRP (C-reactive protein)? That's a marker for inflammation. You want that low. By the way, did I mention that omega-3 fatty acids, of the type commonly found in fish oil, reduce inflammation? I'd be lax if I didn't :)