HDL—the so-called “good” cholesterol—sometimes goes rogue and clogs arteries instead of keeping them healthy, according to a groundbreaking new study published in Nature Medicine Cleveland Clinic researchers have solved a longstanding scientific mystery: despite numerous studies showing that HDL has heart-protective properties.All studies conducted to date on therapies designed to boost Good Cholesterol have failed to show any significant improvement in cardiovascular health The new study is the first to identify the process that not only causes HDL to become dysfunctional, but turns it into a cardiovascular villain by sparking inflammation and atherosclerosis, the clogging and hardening of arteries that can lead to heart attacks.
A New Blood Test to Detect Heart Disease Risk
For more than five years, the research team developed a way to detect dysfunctional HDL, then tested the blood of 627 Cleveland Clinic cardiology patients who had varying levels of total HDL, from high to low. Higher levels of good cholesterol have long been thought to correlate with better Heart Health In the study, however, higher amounts of dysfunctional HDL raised the patients’ risk for cardiovascular disease (CVD)—the leading killer of Americans—regardless of the person’s total level of HDL.
Reports lead study author Stanley Hazen, MD, PhD, Vice Chair of Translational Research for the Lerner Research Institute This finding held true even when other cardiovascular risk factors were taken into account A blood test to detect dysfunctional HDL could be commercially available later this year through Cleveland Heartlab, a spinoff of the Cleveland Clinic, reports Dr. Hazen, who is section head of Preventive Cardiology in the Miller Family Heart and Vascular Institute of the Cleveland Clinic.
Not only could a dysfunctional HDL test help medical providers evaluate patients’ heart disease risk, but “lowering levels of this type of HDL could potentially be a new target of treatment to lower risk,” adds Dr. Hazen “These are great discoveries,” said Jake Orville, CEO of Cleveland HeartLab (CHL), which has licensed this test exclusively from the Cleveland Clinic. “There are many great discoveries especially in Heart Disease What’s important is bringing these tests to market so they can be applied to patient care and make a real impact.”
What Causes HDL to Go Rogue?
Recent studies show that the major protein found in HDL called apolipoprotein A1 (apoA1) is found in an oxidized form in diseased arteries, explains Dr. Hazen In earlier research, the team found that an enzyme in white blood cells, known as myeloperoxidase, or MPO, is the main culprit in turning HDL bad. That finding led to a blood test to detect MPO, which is also available through CHL.
“MPO causes HDL to become both dysfunctional and inflammatory,” says Bradley Bale, MD, medical director of the Heart Health Program at Grace Clinic and coauthor of Beat the Heart Attack Gene. Dr. Bale is also the coauthor of a 2009 case study in which a 60-year-old patient with HDL levels of 100 (very high, which should indicate excellent heart health) turned out to have atherosclerosis.
The patient also had extremely high levels of MPO, which is a sign of arterial inflammation, the fire that ignites heart attacks and strokes by causing plaque deposits to rupture As I reported recently, a 2013 study of more than 95,000 patients found that having elevated levels of MPO is the most predictive marker of heart attack risk in the near future.