My HDL runs between 100 and 115. Has always been high. For years was told that’s great but now we know it could actually be a risk as it might mean that the particles are not functioning well. I have reduced my LDL and Lp(a) using Repatha, Ezetimibe and supplements but the HDL doesn’t budge. Have listened to Daniel Rader, expert on HDL, talking with Peter Attia, but no real insights. Reviewing the literature, it seems that very high HDL might be bad but it might not (depending on particle size). I would like to get a size assay–how to do this??? Also have read that very high HDL (higher than 80) is actually negatively correlated with longevity. But also, that the negative effects seem to manifest in men, but not in women. Also, it is likely caused by genetics. My genetics show risk for atherosclerosis and stroke and there is a suggestion that there is a defect in the gene(s) that control cholesterol re-uptake (SCARB). There seems to be very little that is known for certain but I would appreciate pointers and guidance.
LabCorp has tests that give you particle count and size for LDL and HDL plus the rest of the lipid panel VLDL, trigs etc., I think it’s called NMR Lipo and is about $75 through Marek Health. I’m sure you can get equivalent tests from other labs (and I have, through UCLA too). For HDL you want to pay attention to ApoA1, similar to ApoB for LDL. Generally higher ApoA1 is better (and is somewhat correlated to higher HDL), just as lower ApoB is better (and somewhat, but imperfectly correlated to LDL).
It’s worth paying attention to ApoA-1 for more reasons than CV health. Example:
Apolipoprotein A-I (ApoA-I), Immunity, Inflammation and Cancer
Quest Diagnostics also performs particle size differentiation and quantification. Its ordered as Cardio IQ Advanced Lipid panel. Lot more illuminating than plain lipid panel.
Per an AI, HDL of 100–115 isn’t “dangerous,” but it’s not automatically good, and it’s high enough that it deserves context.
NMR is $38 through good labs at quest (you choose labcorp or quest, but do compare prices of each lab as they are not the same). And yes @Nick1 I had all that done at Quest, too.
If you have not used good labs yet, let me know and I can share my 20% off code for the first order.
Thank you all for the pointers. New York State does not allow these labs to service residents. But I will ask my PCP to test for ApoA1.