High Cholesterol, high LDL, high HDL

In some situations a high cholesterol may be healthy, if HDL levels, triglycerides, and other markers of cardiovascular health are good. You can calculate your risk for developing heart disease here.

Patinets with high HDL levels (60 mg/dL or more) and low levels of triglycerides (less than 100 mg/dL) may actually be at a lower risk for heart disease than people with normal cholesterol levels who have lower levels of good cholesterol (HDL) and higher levels of bad cholesterol (LDL).

There are 2 kinds of LDL cholesterol, A and B, of which B is associated with heart disease. Most labs calculate LDL as follows:

LDL = Total Cholesterol - HDL - (triglycerides/5).

Although this equation is fairly accurate and widely employed by a number of laboratories, there are certain factors that could cause your LDL cholesterol levels to be incorrect:

  • Triglyceride levels over 400 mg/dL or eating just before having your cholesterol levels checked. 
  • This calculation also doesn't diffrentiate between LDL A (no risk)  or B (at risk for heart disease).

Studies have shown that there is a strong correlation between a low triglyceride/high HDL level and LDL pattern A (good kind).

On the other hand, a high triglyceride/low HDL level is strongly associated with LDL pattern B (heart disease risk). In other words,  high triglycerides are an independent risk factor for heart disease. Direct measurements of LDL can also be used in cases where triglycerides are very high.

An example:

Total Cholesterol: 250
LDL: 162 (normal <130)
HDL: 79 (normal >45)
Triglycerides: 42 (Normal <150)

From this you can calculate that in this situation a high LDL must be mostly Type A (good), confirmed by a high HDL and low triglyrerides, therefore there is a very low risk of heart disease.