Your LDL is high, but your HDL is excellent. Doesn't the good cholesterol cancel out the bad?

It's one of the most common questions in primary care, and the honest answer is: not the way most people think

In this episode of the Daily Brief, Dr. Albert Takem explains why a high HDL does not erase the cardiovascular risk of a significantly elevated LDL, where the "good cholesterol" and

"bad cholesterol" labels came from, and how clinicians actually read a lipid panel.

LDL and HDL are not cholesterol itself. They are lipoproteins, particles that carry cholesterol and other fats through the bloodstream. When there are too many atherogenic particles circulating, they can enter the artery wall and contribute to plaque. Evidence from genetics, population studies, and randomized treatment trials points in the same direction: lowering LDL in appropriate patients reduces heart attacks and strokes.

HDL is more complicated. Higher HDL has been linked with lower risk in population studies, but medications that substantially raised HDL did not consistently deliver the expected benefit. A marker linked with lower risk is not necessarily a treatment target. That is why a favorable HDL should never be used to dismiss a high LDL, even in people who exercise, are lean, and otherwise look healthy.

Questions for Dr. Takem and the team

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