We often hear about “good” and “bad” cholesterol, but a new study published in Lipids in Health and Disease argues that simply looking at standard cholesterol numbers may not be enough to know who is really at risk of heart disease. SpringerLink+1
What the Study Did
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Medical data from 898 patients who underwent coronary angiography was analysed. SpringerLink+1
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Rather than using only individual cholesterol or triglyceride measurements, the researchers used a statistical method called latent profile analysis (LPA). This method groups people by their overall lipid patterns (including total cholesterol, LDL, HDL and a triglyceride–glucose index) to define “lipid profiles.” SpringerLink+1
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The goal was to see how those distinct lipid profiles related to the narrowing of heart arteries (stenosis), severity of narrowing, and coronary heart disease (CHD). SpringerLink+1
Four Lipid Profiles: What They Looked Like
The analysis revealed four main lipid-profile groups among patients: SpringerLink+1
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Profile 1: Higher HDL (the “good” cholesterol) combined with the lowest total cholesterol, LDL (“bad cholesterol”), and triglyceride-glucose index. About 41% of patients were in this group. SpringerLink+1
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Profile 2: Higher total cholesterol, LDL, and triglyceride-glucose index, with the lowest HDL. Roughly 36% of participants. SpringerLink+1
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Profile 3: Lower total cholesterol, LDL and triglyceride-glucose index, with moderately high HDL. Around 19% of patients. SpringerLink+1
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Profile 4: High levels of total cholesterol, LDL and triglyceride-glucose index — but also the highest HDL. This was the smallest group (about 3–4% of patients). SpringerLink+1
What They Found: Risk Depends on the Whole Profile
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Patients in Profile 2 — those with high LDL and triglyceride-glucose, and low HDL — had the highest risk of artery narrowing, severe narrowing, and coronary heart disease. SpringerLink+1
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The group with Profile 1 (high HDL, low “bad” lipids) had the lowest risk across all outcomes. SpringerLink+1
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Surprisingly, having the highest lipids overall (Profile 4) did not always mean the highest risk — suggesting that a high HDL may reduce risk even when other lipid measures are elevated. SpringerLink+1
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Most importantly, the overall “lipid profile” approach was far better at expecting who was at risk than traditional methods that consider only individual cholesterol or triglyceride values. SpringerLink+1
Why This Matters: Cholesterol Might Be More Complex Than We Think
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These findings suggest that the “good vs. bad cholesterol” story is too simplistic. Two people with similar LDL levels could have very different heart disease risks — depending on their full lipid profile.
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The results highlight the importance of HDL (good cholesterol) — not just by itself, but in combination with other lipid markers. Low HDL in the presence of high LDL/triglycerides appears particularly risky.
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For both patients and doctors, this could mean a shift toward considering holistic lipid profiles rather than focusing narrowly on a single number.
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In practice, this might allow for more personalised risk assessment and early intervention, helping identify individuals who could otherwise slip through the cracks under conventional screening.
What It Means for You
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If you get a standard blood lipid test, consider asking about the balance between your HDL, LDL, triglycerides — not only the single numbers.
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Keeping a healthy HDL level matters. Lifestyle habits that support HDL — such as regular exercise, a balanced diet, and avoiding smoking — may play a key role in lowering heart-disease risk.
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Even if one cholesterol value seems “normal,” your overall combination of lipid levels might still pose a risk. It may be worth discussing full lipid-profile analysis with your doctor.
