Endocrinologist Isabel Viña: "Low good cholesterol is as bad as high cholesterol; it's associated with an increased risk of cardiovascular disease."

For years, it has been repeated as an absolute truth: the higher the HDL cholesterol, also known as "good cholesterol," the better. However, Dr. Isabel Viña, a specialist in medicine and endocrinology, has now warned through a TikTok video that this statement needs to be nuanced. In a recent post, Viña has offered a more balanced approach. "It's just as bad to have very low good cholesterol as it is to have very high cholesterol," she asserted. In both cases, she says, cardiovascular risk increases .

But what does it mean to have it "too high"? The doctor points out that exceeding 90-100 mg/dL can be a sign that HDL cholesterol isn't fulfilling its function. "What it tells us is that this cholesterol isn't functional, that is, it's not adequately carrying cholesterol to the liver to promote its elimination," she explained. This prevents maintaining the necessary balance in lipid metabolism and can have negative consequences for cardiovascular health.

Viña clarified in her video that these cases are often genetic. In fact, some people produce too many HDL particles as a compensatory mechanism, but these are ineffective. Thus, what might appear to be good news—having high levels of good cholesterol—may actually hide a disorder.

The expert also urged calm. It's not necessary to start treatments to reduce it if the rest of the parameters are in order. "There's nothing you need to do to lower it," she stated. Instead, she advises focusing on optimizing other cardiovascular risk factors such as blood pressure, insulin resistance, LDL cholesterol, and chronic inflammation.

In addition, there is a second group of people who may have elevated HDL levels: cholesterol hyperabsorbers. These individuals, in addition to producing cholesterol in the liver, absorb excess cholesterol through the intestine, which also leads to an increase in good cholesterol.

According to the doctor, optimal HDL levels are between 50 and 70 mg/dL for women and between 40 and 70 mg/dL for men. Outside this range, both above and below, there may be a greater risk to heart health.

Studies confirm it

Although high levels of HDL cholesterol, known as "good cholesterol," have traditionally been thought to protect against cardiovascular disease, several recent studies have challenged this belief. Scientific research has shown that when HDL levels exceed 90 or 100 mg/dL, rather than offering an additional benefit, they may be associated with an increased risk of mortality.

Studies published in journals such as BMC Public Health and the European Heart Journal support this observation, noting that people with extremely high HDL levels are at increased risk of dying from both cardiovascular and non-cardiovascular causes.

Instead of obsessing over raising good cholesterol, experts recommend keeping it within a healthy range (between 40 and 70 mg/dL for men, and between 50 and 70 for women) and focusing on managing other risk factors such as blood pressure, LDL cholesterol, and chronic inflammation. Metabolic balance is essential for good cardiovascular health.