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Big data study shows “good” cholesterol not the best marker for heart health


Elevated high-density lipoprotein (HDL) cholesterol levels have long been praised as a way of reducing or eliminating heart disease but a large-scale study from the Institute for Clinical Evaluative Sciences (ICES) shows HDL or “good” cholesterol isn’t a specific marker for heart health.

“Our study shows that rising HDL cholesterol levels are not the Holy Grail for heart health as we were made to believe for a long time. This may be the reason why drugs that increase HDL levels have not led to improved heart outcomes,” says the study’s lead author Dr. Dennis Ko, who is a scientist at ICES and an interventional cardiologist at Schulich Heart Centre, Sunnybrook Health Sciences Centre.

In the study, the researchers refer to the inability of recent randomized trials to improve clinical outcomes by targeting a rise in HDL cholesterol levels, which has challenged the conventional wisdom that higher HDL levels improve cardiovascular health.

“Our findings suggest that the HDL cholesterol level is not specific to the heart but instead a marker of general health. As such, it may not be an independent modifiable risk factor for cardiovascular disease,” adds Ko.

The researchers examined the relationship of HDL cholesterol levels and cause-specific outcomes in more than 630,000 Ontarians without pre-existing cardiovascular conditions.

The study published today in the Journal of the American College of Cardiology is the largest population-based study to evaluate the association between the full range of HDL cholesterol levels and cardiovascular and non-cardiovascular deaths in individuals living in the same environment and exposed to the same healthcare system.

“We need a change in mindset. Our data does not show that super-high HDL levels reduce the risk further. Instead of only focusing on HDL levels, we also need to focus on improving modifiable risk factors,” says Ko.

The study found individuals with lower HDL cholesterol levels were more likely to have low incomes, unhealthy lifestyle, higher triglycerides levels, other cardiac risk factors and medical comorbidities. Lower HDL cholesterol levels were independently associated with higher risk of cardiovascular, cancer, and other mortality compared with individual in the reference ranges of HDL cholesterol levels.

This project is part of the CANHEART (www.canheart.ca) ‘big data’ initiative, funded by the Institute for Circulatory and Respiratory Health-Canadian Institutes of Health Research.

“High-density lipoprotein cholesterol and cause-specific mortality in individuals without prior cardiovascular conditions” was published today in the Journal of the American College of Cardiology.

Author block: Ko DT, Alter DA, Guo H, Koh M, Lau G, Austin PC, Booth GL, Hogg W, Jackevicius CA, Lee DS, Wijeysundera HC, Wilkins JT, Tu JV.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario


Deborah Creatura
Media Advisor, ICES
[email protected]
(o) 416-480-4780 or (c) 647-406-5996


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