Life Extension Magazine®

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Ask the Doctor

New research shows that high HDL levels may not always help protect against cardiovascular disease. We asked leading cardiologist Dr. Michael Ozner to explain what blood tests people need to get so they can monitor and improve their cardiovascular health.

Scientifically reviewed by Dr. Gary Gonzalez, MD, in May 2022. Written by: Life Extension Editorial Staff.

1 Ask The Doctor

The deadliest killer of men and women, responsible for more deaths than any other disorder, is cardiovascular disease—which includes heart attack and stroke.

“The good news,” says leading cardiologist Dr. Michael Ozner, is that, “cardiovascular disease is virtually preventable with a healthy lifestyle and medications (if needed).”

In this interview with Life Extension® Dr. Ozner discusses new approaches to assessing an individual’s risk factors, preventing illness, and staying healthy. What you may not know about your cholesterol levels could surprise you.

LE: Most people are familiar with their cholesterol levels and the ways in which they may predict risk for cardiovascular disease. Is there anything new you can tell us about that?

Good cholesterol foods

Dr. Ozner: High-density lipoprotein (HDL) cholesterol is commonly referred to as the “good cholesterol.” That’s because it generally carries harmful fats away from the artery wall to the liver for processing and elimination.

Physicians have told people to aim for an HDL cholesterol level of at least 50 mg/dL for women and at least 40 mg/dL for men. Previous research seemed to indicate that lower levels of HDL were linked to a higher risk for cardiovascular disease (CVD). As far as HDL goes, doctors have always assumed “more is better.”

However, new research has shown that high HDL levels may not always help protect against cardiovascular disease. In addition, clinical trials designed to raise HDL cholesterol with medications have failed to reduce the risk of cardiovascular disease.

LE: That’s very important, new information. What else has recent research discovered?

Dr. Ozner: More has been discovered about the structure and function of HDL. It has become clear that HDL can be a double-edged sword. HDL can either be helpful by playing an anti-inflammatory and antioxidant role, or dysfunctional and harmful by promoting inflammation and oxidation.1 In addition, the ability of HDL to remove cholesterol from the artery wall can be variable.

LE: Are you saying that it’s not just about the numbers, the cholesterol levels?

Dr. Ozner: While epidemiology research confirmed the well-established cardiovascular risks for extremely low levels of HDL, the risk or benefit of HDL is dependent on HDL function rather than absolute levels. In addition, low HDL cholesterol is often associated with high triglyceride levels which can be harmful. In fact, several clinical trials looking at genetics demonstrated that it is the elevated triglycerides that cause increased CVD risk, and not the low HDL cholesterol.3

LE: So how can you tell what your HDL level means?

Woman exercising

Dr. Ozner: One way to measure HDL function is to test cholesterol efflux of HDL particles. However, this test is expensive, and not available in commercial labs. Nevertheless, when looking at one’s risk for cardiovascular disease, the key is to remember that your HDL cholesterol level is only one way that doctors assess the risk. Low-density lipoprotein cholesterol (LDL), the so-called “bad” cholesterol, and triglycerides—both of which are linked to increased coronary heart disease risk, must also be factored into your cardiovascular disease risk profile. Non-HDL cholesterol measurement (obtained by subtracting HDL cholesterol from total cholesterol) is also an important marker for coronary heart disease and heart attack risk. Elevated levels of non-HDL are a better predictor of heart disease than LDL cholesterol alone. A normal non-HDL cholesterol is less than 130 mg/dL and an optimal level in individuals at increased cardiovascular risk is less than 100 mg/dL.

LE: Are there new guidelines for optimal cholesterol and triglyceride levels?

Dr. Ozner: While most guidelines recommend an LDL cholesterol level of less than 100 mg/dL, clinical studies show that lower is better and optimal levels are less than 70 mg/dL for those at high risk or with preexisting cardiovascular disease. The normal level for triglycerides is less than 150 mg/dL however optimal levels are below 100 mg/dL.

LE: What other lab tests can help people assess their risk for coronary disease and heart attack?

Dr. Ozner: Your level of vascular inflammation, which is most commonly measured by high sensitivity C-reactive protein (hs-CRP) is also helpful in assessing your risk for CVD. Clinical trials have demonstrated that elevated hs-CRP is associated with increased CVD risk.4,5

LE: What do you think about the data linking apolipoprotein B to increased arterial occlusion risk?

Dr. Ozner: Apolipoprotein B (ApoB), which resides on the surface of all potential atherogenic (harmful) cholesterol particles can enter the artery wall and lead to dangerous plaque buildup. ApoB is the best risk marker for coronary heart disease and heart attack risk. An optimal apoB level is less than 80 mg/dL.

LE: What are low-cost and most important blood tests people should consider doing annually?

Dr. Ozner: Health care providers should focus on more than just the “good and bad” cholesterol levels to assess heart attack risk. A lipid panel (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides and non-HDL cholesterol) and periodically an apolipoprotein B and high sensitivity C-reactive protein measurements are important to assess coronary artery blockage and heart attack risk.

LE: Dr. Ozner, what advice would you give to people concerned about maintaining their cardiovascular health?

Dr. Ozner: It is wise for everyone to be evaluated by their personal physician on a regular basis and to develop a prevention plan before heart disease strikes. Follow well-established heart-healthy habits to keep your risk for cardiovascular disease in check. Eat a healthful diet, such as a Mediterranean-style plan with lots of fruits, vegetables, fatty fish and whole grains. Also, exercise for at least 30 minutes on most days, maintain normal body weight, avoid smoking, manage your stress, and get good-quality sleep.

If you have any questions on the scientific content of this article, please call a Life Extension Wellness Specialist at 1-866-864-3027.

Dr Michael Ozner, M.D.

Michael Ozner, MD, FACC, FAHA, a member of the Life Extension Scientific Advisory Board, is one of America’s leading advocates for heart disease prevention. Dr. Ozner is a board-certified cardiologist, a Fellow of the American College of Cardiology and of the American Heart Association, Medical Director of Wellness & Prevention at Baptist Health South Florida and a well-known regional and national speaker in the field of preventive cardiology. Dr. Ozner is also the author of The Great American Heart Hoax, Heart Attack Proof and The Complete Mediterranean Diet. For more information visit:



  1. Rosenson RS, Brewer HB, Jr., Ansell BJ, et al. Dysfunctional HDL and atherosclerotic cardiovascular disease. Nature reviews Cardiology . 2016;13(1): 48-60.
  2. Madsen CM, Varbo A, Nordestgaard BG. Extreme high high-density lipoprotein cholesterol is paradoxically associated with high mortality in men and women: two prospective cohort studies. European heart journal. 2017;38(32):2478-2486.
  3. Do R, Willer CJ, Schmidt EM, et al. Common variants associated with plasma triglycerides and risk for coronary artery disease. Nature genetics. 2013;45(11):1345-1352.
  4. Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. The New England journal of medicine. 2008;359(21):2195-2207.
  5. Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. The New England journal of medicine. 2017;377(12):1119-1131.