 [ Symptoms ] why does not my high hdl cholesterol number necessarily mean i am in great shape [ Disease ] i hear every single day from family friends and other doctors that they are in great shape because their hdl cholesterol the good cholesterol is high and that is the most important number to look at in a lipid panel well guess what everyone unfortunately many of you are quite wrong and i will explain why we know that low hdl cholesterol good cholesterol is a major risk factor for cardiovascular morbidity and mortality it is included in the most well known risk factor scoring system for cardiovascular disease called the framingham scoring surprisingly there is little clinical evidence that therapies directed at raising hdl cholesterol reduce risk i will say that again there is little evidence that raising one is good cholesterol number protects them from having a heart attack a stroke or dying for this reason the national cholesterol education panel ncep does not specify a number that would be the “optimal” hdl level of therapy ncep also states that raising one is hdl is not a primary or secondary goal of therapy in order to reduce cardiovascular events or death ncep atp iii statements about low hdl cholesterol were published in the journal circulation in 2002 here is a selection of facts from the article * a categorical low hdl c should be defined as a level of less than 40 mgdl in both men and women * whether raising hdl per se will reduce risk for chd has not been resolved still true in 2010  * some persons with severe deficiency of hdl do not manifest premature coronary heart disease this suggests that hdl is not uniquely involved in atherogenesis clogging of the arteries as is ldl cholesterol the bad cholesterol * a specific hdl cholesterol goal level to reach with hdl raising therapy is not identified in summary when we measure hdl cholesterol we are just measuring a number that tells us nothing about how well it functions there is no way yet to measure how well one is hdl functions and thus if one is level is within normal limits does the person with a higher hdl number have fewer events than a person with lower hdl number this has never shown to be true in any randomized prospective human studies this is also defined in scientific terms as no level 1 evidence there is only data in retrospective and epidemiological studies that show that the higher the hdl cholesterol number the lower the cardiovascular event rate i will put another twist in the hdl discussion there is a level at which the hdl cholesterol in some people may be too high and dysfunctional and actually be harmful to the arteries there is another group of people whose hdl is called apoa1 milano who are all originally from limone italy and have very low levels of hdl cholesterol approximately 3 5 percent of these people have hdl levels below 10mgdl and have virtually no evidence of cardiovascular disease whatsoever this is a kind