Myths vs facts: HDL and longevity

HDL (high-density lipoprotein) is often called 'good cholesterol,' but its link to longevity is more nuanced than the common myth suggests. Fact: Epidemiological studies consistently show an inverse association between HDL cholesterol levels and cardiovascular disease risk – higher HDL is linked to lower risk. Myth: Artificially raising HDL through drugs (e.g., niacin, CETP inhibitors) does not reliably reduce mortality or extend lifespan, as shown by large randomized trials and Mendelian randomization studies. The function of HDL – its ability to promote reverse cholesterol transport and exert anti-inflammatory effects – may matter more than the absolute level. Lifestyle factors like regular exercise, moderate alcohol intake, and a Mediterranean diet can raise HDL naturally, but their longevity benefit likely comes from multiple pathways, not HDL alone. For most people, having HDL in the normal range (men >40 mg/dL, women >50 mg/dL) is favorable, but extremely high levels are not necessarily protective and may even signal dysfunction. Caveat: No single biomarker determines longevity; the full lipid profile, inflammation markers, and lifestyle habits are far more predictive. Evidence: human-strong for association, human-moderate for causality.