DEAR DR. ROACH: I’m a healthy and fairly active 62-year-old female. My blood pressure and cholesterol levels have always been very good, and there’s no history of heart issues in my immediate family. At my last checkup, my total cholesterol was 178 mg/dL; my LDL was 81 mg/dL; my triglycerides were 61 (all a bit high for me); and my HDL was 87 mg/dL.

When reviewing these numbers, I noticed that some research suggests that an HDL over 80mg/dL is too high and can possibly lead to heart or stroke issues down the road. Can you comment on what is “too high” of an HDL? — E.P.

ANSWER: Low levels of HDL cholesterol are known to be associated with a higher risk for heart attacks, while high levels of HDL are generally protective. However, there are a few exceptions to this rule:

In some people with a strong family of heart disease and high HDL cholesterol levels, the HDL particles were found to be different from normal HDL particles and weren’t protective against inflammation in a cell culture. For this reason, I look at family history as a very important risk factor, which is not taken into account by most of the scoring systems that allow doctors to estimate heart disease risk. (Interestingly, the use of a statin drug helped the abnormal HDL particles work more effectively.)

Diabetics who are on insulin often have high HDL levels, which cannot be considered protective. There is also an unusual type of HDL particle found in an Italian village called ApoA-1 Milano that is highly protective against heart disease, even with low HDL levels.

I suspect that in the future, we will be looking at function (instead of just levels of cholesterol types and related proteins) to predict heart disease and determine who would benefit from medication. For right now, a scoring system such as PREVENT, modified by family history, remains the best place for most people to start.

People with a strong family history and normal or low cholesterol levels should consider additional testing, such as Lp(a), a lipoprotein that predicts heart disease.

DEAR DR. ROACH: What is your opinion on the new Galleri blood test that can help detect cancers for which there are no early screening? Like many people my age (66), I’ve known too many people who have died of pancreatic cancer that was caught too late. — Anon.

ANSWER: Unfortunately, the test isn’t this helpful yet. It’s a very good test, but screening for a rare disease is limited by the fact that many people need to be screened to find even one case. The test would have to be near-perfect for it to be useful, and the current version of cell-free DNA testing isn’t quite there.

The sensitivity of the test is about 30%, meaning that it will miss more than two-thirds of people with pancreatic cancer. Most people would assume that a negative test means they don’t have the disease, but this isn’t exactly true. It’s possible that the false sense of security could keep a person from mentioning early symptoms to their doctor.

The main problem is when the test result is positive. A person who receives the devastating news that their test is positive for pancreatic cancer as part of a screening might be surprised to learn that only 2.2% of positive tests indicate pancreas cancer. Nonetheless, they are likely to require additional, expensive, anxiety-provoking and possibly invasive tests to conclude that the test was a false positive.

Due to the poor sensitivity and low positive predictive value of the test, I am not recommending it. But this technology may eventually be improved to overcome these limitations.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved