This is an archive article published on November 29, 2022

Is your HDL (good cholesterol) an indicator of heart disease risk? Why Indians need to worry about LDL (bad cholesterol) more

We have lower HDL levels as compared to the Western population. So, we should focus on lowering LDL and triglycerides, say experts

5 min readUpdated: Nov 30, 2022 12:23 PM IST

$The study, published in the Journal of American Cardiology, is significant, say cardiologists, noting that there is a need to look beyond a single lipid fraction. This holds particularly true among Indians (Representational: Pixabay)$ The study, published in the Journal of American Cardiology, is significant, say cardiologists, noting that there is a need to look beyond a single lipid fraction. This holds particularly true among Indians (Representational: Pixabay)

Is a low level of high density lipoprotein (HDL), or what we call “good cholesterol,” warning enough of an increased risk of heart disease? A latest study by REGARDS (Reasons for Geographic and Racial Differences in Stroke) found that while HDL is singularly linked with an increased risk of heart disease in White Americans, it alone was not a trigger among African-American adults.

The study, published in the Journal of American Cardiology, is significant, say cardiologists, noting that there is a need to look beyond a single lipid fraction. This holds particularly true among Indians. For us HDL levels matter very little in countering the effects of low-density lipoprotein (LDL) or bad cholesterol. This leads to fatty build-ups in arteries, narrowing them and increasing the risk for heart attack, stroke and peripheral artery disease.

“It is more like a combination key than a single key turning the atherosclerotic lock,” says Dr K Srinath Reddy, honorary distinguished professor at Public Health Foundation of India (PHFI).

Why Indians should be more worried about LDL, Triglycerides

Story continues below. Subscribe to see fewer ads.

“Indians have a low HDL. They say 50mg/dL HDL is ideal to neutralise LDL but in Indians, that level never crosses 45 mg/dL in the best of times. Which is why we should only focus on the LDL levels and keep them low. In fact, over the last three decades, the safe limit for LDL has been pushed down and for Indians, who are genetically prone to cardiac conditions, the LDL levels are the only concern,” says Dr Balbir Singh, Chairman, Cardiac Sciences, Cardiology, Cardiac, Electrophysiology-Pacemaker, Max Hospital, Saket.

“Internationally, they prefer LDL levels to be less than 70 mg/dL but for Indians, I would say less than 50 mg/dL. Heart disease among Indians is compounded by additional risk factors like family history, smoking, stress, hypertension and diabetes. So many young Indians are getting a stent in early ages,” he says.

The other worrisome factor is triglycerides. “LDL levels need to be reworked for some people in combination with co-morbidities, high triglycerides and body weight. Triglycerides are blood fat, which along with cholesterol, cause plaque build-up. Therefore, both triglycerides and LDL levels need to be significantly lower,” says Dr Singh.

What elevated small, dense LDL, low HDL and high triglycerides do to Indians

Story continues below this ad

In the Indian context, “We have lower HDL levels as compared to the Western population and here the role of genetics, low levels of physical activity and inadequate diet have to be considered,” says Dr Ambuj Roy, Professor in Cardiology, All India Institute of Medical Sciences, New Delhi.

“However, there are sub-fractions of HDL and LDL which have different effects,” says Dr Reddy. Small dense LDL has an atherogenic effect whereas high buoyant LDL fraction does not. HDL sub-fractions too have different effects. High triglyceride levels also correlate with an elevated small, dense LDL fraction. “In metabolic syndrome, common in Indians, a combination of elevated small, dense LDL, low HDL and high triglycerides is seen. This raises the risk of vascular disease. Since small, dense LDL is not easy to measure, a high triglyceride to HDL ratio is often used as a surrogate marker for elevated small dense LDL levels,” the cardiologist points out.

According to Dr Reddy, “small, dense LDL are smaller but more densely packed with lipids. They are more numerous than big buoyant LDL particles. That’s the reason they increase the risk of atherosclerosis in the blood vessels. High levels of plasma triglycerides increase the risk of acute coronary events. Together they markedly enhance the risk of heart attacks.”

Ethnic variations in blood lipid levels and disease associations

All of these studies go to show that we should not be looking at a single lipid fraction or sub-fraction in isolation. The levels of other lipid fractions appear to modify the effects. The level of insulin resistance also matters. “The lesson we must heed is that human physiology is a complex adaptive system and a reductionist approach of chasing a single molecule seldom works,” says Dr Reddy.

HDL-elevating drugs have not helped Indians

Story continues below this ad

HDL is a field actively researched and we need longitudinal studies to understand disease associations. Generally, those with low HDL levels are assumed to be at risk of heart disease. However, drugs that have been used to raise HDL levels have not shown to reduce heart disease, says Dr Roy, adding that this is a broad field and several factors are yet unexplained.
“Earlier trials of HDL elevating drugs were not successful in prevention of coronary disease,” adds Dr Reddy. Dr Bhushan Bari, senior cardiologist at Manipal Hospital, also observed that in their clinical setting, they get several patients suffering from a heart attack but they had absolutely normal HDL and LDL levels. “This only confirms that factors like lifestyle, stress and family history need to be taken into consideration rather than high LDL and low HDL levels,” he says.

(With inputs by Rinku Ghosh)

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

📣 For more lifestyle news, click here to join our WhatsApp Channel and also follow us on Instagram

Tags:
cholesterol

Loading Recommendations...

Sep 22: Latest News

Live Blog