Cardiovascular health: Not all good cholesterol is good

A study by the Hospital del Mar Institute for Medical Research in Barcelona shows that only HDL cholesterol made up of small particles has beneficial effects on the cardiovascular system.

The cholesterol film thickens. Millions of times the words LDL / bad and HDL / good cholesterol have been paired, although some pointed out that not all LDL was bad, but only the oxidized form. Now a study led by the Hospital Del Mar Medical Research Institute (IMIM) in Barcelona concludes that not all HDL cholesterol is good (it does not have a protective effect against cardiovascular diseases).


The work of the IMIM scientists shows that people with large HDL particles have an increased risk of myocardial infarction, while only small HDL particles are associated with a decrease in this risk.

Until now, it was assumed that HDL cholesterol (linked to high-density lipoproteins) was associated with a lower risk of cardiovascular disease because it carries cholesterol deposited in the arteries to the liver, where it is eliminated. Now it has been proven that this benefit can only be attributed to the small HDL cholesterol particles, but not to the large ones. Bad LDL cholesterol (linked to low-density lipoproteins), on the other hand, causes the accumulation of cholesterol in the arteries and increases the chances of experiencing a cardiovascular disorder.

Scientists have analyzed the genetic characteristics that determine the size of good cholesterol particles, and subsequently studied its relationship with the risk of experiencing a heart attack. The conclusion is that the genetic characteristics associated with the generation of large HDL cholesterol particles were directly related to a greater risk of heart attack, while the genetic characteristics associated with small HDL cholesterol particles were related to a lower risk of heart attack.

“There is a positive causal relationship between the size of the HDL cholesterol particles and the risk of heart attack, therefore, we have to increase the levels of good cholesterol in the blood, but always in small particles”, has pointed out researcher Roberto Elosua .

Small particles of good cholesterol are more effective at transporting cholesterol to the liver for elimination. “If we have to do something with HDL, it is to increase the number of small particles, which are those that adequately perform the function of eliminating cholesterol, which actually transfer it to the liver for elimination and do not allow it to accumulate in the arteries and causes cardiovascular diseases,” says Dr. Álvaro Hernáez, who has also participated in the research.


Currently there are no drugs that increase blood levels of really good cholesterol and reduce the risk of developing cardiovascular diseases.

As is known, diet influences the proportions in which each type of cholesterol is present in the arteries. Future studies should determine which specific foods promote the increase in the small particles of HDL cholesterol, the “new good”. Until now, the studies, although they did not take this variable into account, showed a beneficial association between the risk of cardiovascular disease and natural foods rich in monounsaturated fats (especially extra virgin olive oil and avocado) and unsaturated fats of the omega-3 family (present in oily fish and in some nuts and seeds, such as flax seeds and walnuts).

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