Health Query Responses
Dear Dr. Roach: I’m a healthy, active 62-year-old woman. My blood pressure and cholesterol levels are generally good, with no family history of heart conditions. Recently, my blood test showed a total cholesterol of 178 mg/dL, LDL of 81 mg/dL, triglycerides at 61, and HDL at 87 mg/dL, which felt a bit high for me.
I came across some research stating that having an HDL over 80 mg/dL might be too high and could potentially lead to heart issues later. Could you clarify what constitutes “too high” for HDL?
— E.P.
Dear E.P.: Typically, low HDL levels correlate with a higher risk of heart attacks, while high levels are usually considered protective. But there are a few caveats:
In cases where individuals have strong family histories of heart disease and high HDL levels, the HDL particles might be different than usual and may not provide the expected protective benefits against inflammation. Because of this, I find family history to be a crucial risk factor, which many scoring systems overlook when assessing heart disease risk. Interestingly, statin medications have shown some effectiveness in improving the function of these irregular HDL particles.
Diabetics using insulin often display elevated HDL levels, which don’t seem to confer protective benefits. There’s also a rare form of HDL, known as ApoA-1 Milano, found in a specific Italian village that offers strong protection against heart disease, even in individuals with low HDL levels.
I suspect that moving forward, we may focus more on the functionality of cholesterol types rather than just their levels to predict heart disease and identify candidates for medication. Currently, a scoring system like PREVENT, adjusted for family history, is still a solid starting point for most people.
Those with a prominent family history, but normal or low cholesterol levels, might want to explore additional tests, such as Lp(a), which could predict heart disease risk.
Dear Dr. Roach: What do you think of the new Galleri blood test designed to detect cancers without early screening methods? Like many in my age group (66), I’ve lost too many to pancreatic cancer that was discovered too late.
— Anon.
Dear Anon: Unfortunately, the test isn’t particularly effective right now. While it’s an interesting technology, screening for rare diseases like pancreatic cancer can be tricky because you need to screen many individuals to find even one case. The test would need to be nearly flawless to be worthwhile, but the existing version of cell-free DNA testing isn’t quite there yet.
The test has about a 30% sensitivity rate, which means it could miss more than two-thirds of pancreatic cancer cases. Many might think a negative result means they’re in the clear, but that’s not necessarily true. This could create a false sense of security and discourage individuals from discussing early warning signs with their doctors.
The main concern arises when a person receives a positive result. They might be alarmed to find out that only about 2.2% of positive results indicate pancreatic cancer. Yet, they would likely still require further, costly, and potentially invasive testing to confirm that the initial positive result was a false alarm.
Given its low sensitivity and predictive value, I can’t recommend this test at the moment. However, it’s possible that future advancements could address these drawbacks. Readers are welcome to send questions to ToYourGoodHealth@med.cornell.edu.
