Health Answers

Does total cholesterol need to be lowered if good cholesterol is just as high as bad?

By Courtney Humphries
March 21, 2011

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Q. Do I need to lower my total cholesterol if my good cholesterol is as high as the bad? Can I lower one without lowering the other?

A. “The effects of the bad cholesterol and the good cholesterol are independent of each other,’’ says Richard Karas, director of the Preventive Cardiology Center at Tufts Medical Center. In fact, he says, clinicians are moving away from relying on total cholesterol as an indicator of health. It’s more important to weigh each number separately.

The reason is that each kind of cholesterol acts independently from the other. LDL (low density lipoprotein) or so-called “bad’’ cholesterol is the one that builds up inside arteries and can cause blockages. HDL (high density lipoprotein) or “good’’ cholesterol helps keep blockages from forming. But while they have opposite effects, good cholesterol doesn’t simply cancel out the bad. Karas compares it to trying to prevent a car from moving by keeping the emergency brake on while pressing on the gas pedal.

While you should feel good that your HDL is high, you may still need to intervene to lower your LDL, depending on how elevated it is. Randall Zusman, director of the division of hypertension at the Massachusetts General Hospital Heart Center, says the decision depends on your health status, including diabetes, high blood pressure, a previous heart attack, family history of heart disease, and lifestyle. Your triglyceride levels are also important to consider. Your doctor can help you sort out whether you need to make behavioral changes or take cholesterol-lowering medications.

Although it’s not always possible to lower LDL without also lowering HDL, it may be worth a small reduction in the good cholesterol if you need to reduce the bad kind significantly. Zusman says that the best way to achieve a better cholesterol profile is to make lifestyle changes. Exercising regularly can lower LDL while boosting HDL, and has a host of other benefits to the body. Losing weight if needed can also help, as can limiting excessive carbohydrates and fats, and eating lots of fruits, vegetables, and whole grains. Quitting smoking can raise HDL and improve heart health, and drinking alcohol in moderation can boost good cholesterol — up to one drink a day for women and two drinks a day for men. If your doctor recommends medications like statins to control your LDL, many lower LDL while having a neutral or positive effect on HDL.

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