Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients.

Podcast Summary

Introduction

Dr. Warrick Bishop, a practicing cardiologist and author dedicated to patient education about heart health, hosts this episode with special guest Dr. Karam Kostner, a cardiologist specializing in cholesterol and lipids. Together, they explore high-density lipoprotein (HDL) cholesterol—what it is, how it works, and what influences its levels in the body.

Key Takeaways:

• HDL is called "good cholesterol" because it transports cholesterol back to the liver for excretion, acting as the body's natural regulator of cholesterol levels.

• HDL levels are primarily genetically determined, controlled by apolipoproteins like apolipoprotein A1, though lifestyle factors can modify these levels.

• HDL particle size and composition vary significantly—smaller HDL particles can be more effective at reverse cholesterol transport than larger ones, making HDL assessment more complex than LDL evaluation.

• Lifestyle factors that reduce HDL include smoking, obesity, and diabetes, while exercise, weight loss, and moderate alcohol consumption increase HDL levels.

• Hormonal changes such as menopause in women and testosterone use in men can negatively impact HDL levels.

• Common medications to raise HDL include niacin and fibrates, which are particularly useful for diabetics and those with metabolic syndrome; however, CETP inhibitors that dramatically increase HDL have not been shown to reduce cardiovascular events.

• Emerging experimental approaches like injecting apolipoproteins to create more effective HDL show promise in early trials but lack large-scale clinical evidence for practical use.

• HDL testing is minimally affected by fasting status (only about 5% variation), unlike triglyceride testing which requires fasting.

• While diets rich in monounsaturated fats and omega-3 oils may increase HDL, they often also increase LDL and total cholesterol, potentially negating protective benefits.

• HDL is protective only to a certain degree; high HDL cannot fully compensate for elevated LDL or other poor lipid profiles in preventing coronary disease.