A Revolution in Cholesterol Testing: Why HDL Is Losing Its Relevance

Poland is shifting its approach to cardiovascular risk assessment as doctors move away from prioritizing “good” HDL cholesterol in favor of more precise metrics like non-HDL cholesterol, apoB, and lipoprotein(a).

The Myth of the Good Cholesterol

For years, patients and doctors relied on a simple binary: LDL as “bad” and HDL as “good” cholesterol. While epidemiological data once suggested that high HDL levels reduced cardiovascular risk, recent studies show that pharmacological efforts to raise HDL do not consistently prevent heart attacks or strokes.

Experts are now shifting their focus toward indicators that more accurately reflect the number of particles responsible for atherosclerosis development. New guidelines from the Polish Society of Laboratory Diagnostics and the Polish Lipid Association emphasize the increasing clinical importance of non-HDL cholesterol, apolipoprotein B (apoB), and lipoprotein(a).

Lipoprotein(a) Enters Public Prevention

As of May 2025, the state-funded “My Health” program has integrated lipid profile assessments, including a once-in-a-lifetime test for lipoprotein(a) for adults. This is a significant shift, as Lp(a) levels are largely determined by genetics rather than lifestyle, making them a crucial indicator for high-risk patients who might otherwise appear healthy.

ApoB and the Nuances of Risk Assessment

While LDL remains a primary treatment target, doctors are increasingly analyzing apoB because it represents the actual number of particles capable of depositing in arterial walls. Two patients with identical LDL levels may face vastly different risks depending on their metabolic health, comorbidities, and specific lipid markers like apoB and Lp(a).

The Shifting Landscape of Lipid Profiles

While traditional lipid panels still include HDL and total cholesterol, their diagnostic value is diminishing. Experts, including Prof. Bohdan Solnica, note that the standard lipidogram is evolving. Patients should no longer rely on a single, “normal” result, as modern clinical practice now integrates multiple parameters to determine an individual’s true cardiovascular risk.