The dialogue in this thread has been good with lots of informative posts. Thanks to all. This is what I've learned so far (I think):
1. A risk factor is a factor that is associated with a condition. It is not necessarily causal. A borrowed example: Yellow fingers are a risk factor for lung cancer, but obviously not causal.
2. There is disagreement in the scientific community regarding the role of cholesterol and dietary fat in CVD.
3. Many agree that the smaller dense particles of LDL (not normally measured by a standard lipid profile) are the most dangerous.
4. Most agree that high triglycerides and low HDL are risk factors for diabetes and CVD.
5. A low carbohydrate diet, particular one low in refined carbs, generally reduces triglycerides.
6. A low carbohydrate diet usually means an increase in dietary fat.
7. An increase in dietary fat may cause an increase in HDL, LDL, and total Cholesterol.
8. Dietary cholesterol has little effect on serum cholesterol.
9. A low fat, high carbohydrate diet, particularly refined carbs, is a risk factor for high triglycerides and low HDL.
10. Statins are effective in lowering LDL and total cholesterol. They are not very effective in raising HDL
11. Statins carry some risk, yet to be adequately quantified, but considered minimal at this time.
12. Statins may offer some benefit beyond lowering LDL, yet to be adequately identified and quantified.
13. Statins seem to offer some protection from CVD, though there is some disagreement as to the mechanism involved, whether it is by directly lowering LDL or through some other means.
14. Niacin raises HDL.
15. Fish oil lowers triglycerides.
16. There is a relationship among Vitamin D, LDL, HDL, triglycerides and thyroid function, but the nature of the relationship is unclear.
In late February, I discontinued my statins and started on a high fat, low carb diet. This resulted in a weight loss to date of 20 lbs., a drop in triglycerides from 188 to 116, an increase in HDL from 32 to 40, an increase in LDL from 84 to 149, and an increase in total cholesterol from 158 to 212. I discontinued statins to see if my conditions of disturbed sleep and daytime fatigue would improve. They did not.
Concerned about the increases in cholesterol, I had an NMR lipid profile done. That’s the kind that measures particle size and number. Here’s what I found in addition to the above numbers: My LDL-p (particle number) was high at 1979. My HDL-p was low at 29.6, and my small LDL-p was high at 689.
The test interpretive information indicates that I have a higher than average risk of CVD based on low HDL-p and high small LDL-p and a slightly lower than average risk based on LDL size (I am slightly pattern A). The test also uses the data to assess insulin resistance, with me being slightly insulin sensitive (a good thing).
So, to improve my risk assessment, I must continue to lower my triglycerides, continue to raise my HDL, and try to reduce my small LDL-p. Given that I have diagnosed CAD, I must try to improve my risk factors in attempt to slow the progression even if some of the factors are not actually causal.
Here’s my plan. I will restart statins in attempt to lower LDL particle number. I will continue my high fat, low carbohydrate diet for the favorable effects on large LDL, HDL, and triglycerides. I will begin supplementation with niacin (I think) to raise HDL, continue fish oil supplements to lower triglycerides, and continue current Vitamin D and thyroid supplementation. I will retest quarterly with a standard lipid profile and semiannually with the NMR, adjusting diet, medications, and supplements in an attempt to achieve a lower perceived risk of CAD.
For interest, here is the NMR (red X's are mine). Your comments , questions, and suggestions are welcome.
Jay
