Myths vs facts: HDL and Langlebigkeit

The myth that high HDL cholesterol automatically means a longer life persists. Large epidemiological studies do show an inverse association between HDL-C and cardiovascular events. However, randomized trials of drugs that raise HDL-C (e.g., CETP inhibitors) have failed to demonstrate longevity benefits. Furthermore, Mendelian randomization studies suggest HDL-C is not causally protective. HDL functionality—particularly cholesterol efflux capacity—appears more important than the concentration alone. Very high HDL levels (>90 mg/dL in men, >100 mg/dL in women) are even linked to increased all-cause mortality. Bottom line: HDL-C is a risk marker, not a direct target for extending lifespan. A healthy lifestyle (exercise, Mediterranean diet, moderate alcohol) modestly raises HDL, but the benefit likely stems from the overall pattern rather than the HDL number. Evidence is mixed: observational data are strong, but causal proof is lacking.