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What I know about cholesterol is minuscule compared to you guys. In simple terms is this article spot on?

Two laboratory machines have played a role in perhaps the greatest medical misadventure of our time: the indictment of a villain — LDL cholesterol — with the ultimate crime of the heart, coronary artery disease.

(there are) four major types of independently behaving LDL, each with its own implications for heart disease. We ignore the distinctions at our peril.

Some of these forms of LDL are relatively safe and some are dangerous, and treating them all as one and the same — the way we do every time we pay our clinic for a three-part lipid panel that simplistically says "LDL: 125" — is telling us little about the LDL cholesterol that matters, all the while sending health costs through the roof. We may be medicating many people who have no clear need for medication, using drugs that don't target the right particles, and replacing foods that are benign with foods that are anything but.

Here is the entire article -> http://www.msnbc.msn.com/id/35058896/ns ... you-think/

Maybe the info in the article is out of date?

Absolutely spot on.

When you get a "lipid panel" you get a total LDL number (along with total cholesterol, HDL, and triglycerides). The lab does not count the LDL particles in your blood, but they calculate the number of LDL particles from the other data. The most common equation for calculating total LDL is known as the "Friedenwald formula", and it becomes inaccurate if your triglycerides fall below 100 (low triglycerides is a good thing). So some people are treated for "high cholesterol" based on that incorrect calculation. Once the triglycerides fall below 100, another formula, known as the "Iranian formula" gives a more accurate calculation of LDL particles. But labs persist in using the Friednwald formula only, even when triglycerides are low. Many primary care physicians prescribing cholesterol lowering drugs based on the total LDL number in labs don't appreciate the difference.

As you point out, regardless of which formula you use, the calculated LDL is still not the entire picture of LDL cholesterol. It tells you the number (LDL-C), but not the concentration of "safe" or "dangerous" (using that article's terms) LDL (LDL-P) in the bloodstream. There are tests to determine the concentrations of those types of LDL particles (VAP and NMR) but they are expensive, not always covered by insurance, and not well known to primary doctors.

Meanwhile, many will be prescribed cholesterol drugs based soley on often inaccurate LDL-C calculations. If triglycerides are low and HDL is high (understanding that recent studies may dispute the benefit of high HDL), they can make an educated guess that the types of LDL particles are more benign, but often that is not considered and drugs are still prescribed. Drugs that may lower the "safe" along with the "dangeroud" LDL, and not result in any significant reduction in cardiovascular risk.

Statins May Cut Cancer Risk Post Heart Transplant

Statin therapy may help prevent the high long-term risk of cancer among heart transplant patients, researchers found.

After adjustment for age, sex, cardiomyopathy, and immunosuppressive therapy, cancer-free survival was 67% better among statin users in the cohort.

Prior studies have shown statins to have an impact on not only atherosclerosis in the new heart but also overall survival among heart transplant patients.

http://www.medpagetoday.com/MeetingCoverage/HFC/32819

Statins May Improve Stroke Outcomes

In a large cohort of ischemic stroke patients, those on statins before and during admission had a 38% increase in the chance of being discharged home
On the other hand, those who had their statins withdrawn during the admission for stroke were 23% less likely to be sent home, they found.

One implication, the researchers concluded, is that "ischemic stroke patients should be treated with a statin at the time of stroke hospitalization."

The findings are consistent with mounting evidence of the benefits of statins, including improved survival after ischemic stroke,
http://www.medpagetoday.com/Cardiology/Strokes/32804

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

Jay, fascinating. I hope you will keep us posted with your results.

I think it would be interesting to take a look at your CRP levels too, since inflammation seems to be a factor in CVD. And how's your thyroid?

Are you still eating grains at all?

One other thing Jay, how about your fasting blood glucose leves and your HBA1C? Does it correlate with your NMR findings?

Jan, thanks for your interest.

I see my doctor tomorrow and I want to make sure that we include CRP in the next blood work (next week). My last CRP was normal, but as I recall it was high normal. I don't have it immediately available. My thyroid (FT3 and FT4) have been brought into normal limits with levothyroxine. My Vitamin D3 has been raised to around 60 with supplementation and my Vitamin B12 has been brought up above 500 with supplements.

I don't recall ever having an HBA1C, but my last glucose tolerance test administered about a year ago was normal. My fasting blood sugar has slowly risen over the years to 100+; hence, the glucose tolerance test. I think the highest I've seen is 112. I do my own since I have access to a glucometer and since starting the low carb diet, my readings have been under 100, but close, like 98 or 99. I haven't seen a clear trend down, but neither have they been going up. So, the assessment by the NMR of insulin resistance might be close.

As for grains, no I'm not eating any. I'm eating somewhere around 50 to 60 grams of carbohydrates per day, mostly from above ground vegetables but I might have a piece of fruit like an apple or an orange or some melon during the day and occasionally beans like pinto or black in place of meat. My original intent was to stop eating processed food, which I did. But then, I kind of drifted into the HFLC camp. A rather easy and logical follow-on to the no processed food idea.

So, on with the plan. I'll be sure to keep you posted.

Jay

You're doing great, Jay.

But I forgot the most important question.

How do you feel????

Janknitz wrote:You're doing great, Jay.

But I forgot the most important question.

How do you feel????

Ha ha, that's kind of funny. Through all my changes in diet, medications, and supplements I haven't felt much different. Pretty good on days following nights of restful sleep. Not so good otherwise. Unfortuantely, the otherwise seem to be in the majority as I struggle with lack of deep and fractured sleep. With my OSA well controlled, I continue to look for other ways to improve my sleep. I have had some good results with Vitamin D, but for me it seems difficult to get the dosing right.

Jay

Saw my doctor today and she less than enthusiastically endorsed my "plan" (see previous post). Her approach is strictly by the numbers, LDL > 100, administer statin. HDL > 40, OK. Diet - low fat, low refined carbs.
Most surprising to me was when I presented her with my NMR lipoprofile (again, see previous) she was not at all interested. It seems this test has not been embraced by the ACC and standards of care have not been established for the results, so she has no where to turn for recommended treatment. I can understand that, but it seems a doctor would have some professional interest in such a test. She would not even accept a copy for my health record. Although, she is an internist not a cardiologist.
But, she did accept my plan which was to restart my statins (at a higher initial dose than I was taking) to bring down my LDL, and continue with my low carb diet and supplements I previously mentioned. She wants to wait 3 months before adding niacin to improve HDL in the hopes the statin dosage can be reduced so as to reduce liver damage risk from the combined drugs. She saw my HDL now > 40 as not requiring intervention. I agree with the strategy from a liver damage risk point of view, but still would like to see HDL higher.
So, we're off on the HFLC with statins plan and we'll get the first results in about 90 days.

Jay

I hope you'll repeat the NMR, because it will be interesting to see what happens to LDL-P on statins.

Peter Attia's series "The Straight Dope on Cholesterol" http://eatingacademy.com/nutrition/the- ... ol-part-vi continues to fascinate.

Thanks for the post, Jan, I hadn't seen this latest installment of "The Straight Dope on Cholesterol" yet. I'm anxious for installment VII when Dr Attia will hopefully give his views on what to do about high LDL-p. As you recall, my LDL-p was elevated as measured by my recent NMR lipoprofile (see previous post) and I have taken steps to reduce it by restarting my statin while continuing on the HFLC diet. I chose this path because current thinking seemed to be that the risk of CAD seems to correlate with higher LDL-p as well as with higher triglyceride levels. I'm hoping the statin will bring down the LDL-p and Low carbs will bring down triglycerides. So far, we know that the HFLC has reduced my TG level some 70 points or so.

I plan to monitor my results monthly with a standard lipid profile and quarterly with an NMR and I will post them.

BTW, my last CRP was 1.1, where <1 is low, 1 to 3.0 is moderate, and >3.0 is high CVD risk.

We'll see how it goes.

Jay

You need exercise in your plan if you want to raise your HDL, niacin can only do so much (also make sure the niacin type/amount creates facial heat flush -- ie nicotinic acid).

In particular, you need high intensity interval training (MAKE SURE TO CLEAR HEART HEALTH WITH YOUR DOC FIRST).

Get yourself a Schwinn Airdyne upright exercise bike off your local Craigs list and do sprints. Go all out effort (pretend you're being chased by a hungry lion) for as long as you can then slow down (not stop) until you catch your breath then rinse and repeat for a total of about 15 to 20 minute session (5 minute warm up and warm down included) -- do one session once or twice per week. Your HDL will shoot up 20 to 30 points within a month.

Also cut back on your fruits and beans to every other day instead of daily -- or better yet, only on days that you exercise.

FYI - There is a genetic test you can take to see if statins are beneficial or useless for you ... Google: Berekly KIF6 Genotype test. IMO, statins are a waste of money even if KIF6 test suggests benefits. Statins reduce natural Coenzyme Q10 availability for your body, a very important enzyme for your cellular mitochondria. So if you do decide to use statins, you should supplement with Coenzyme Q10 preferably Ubiquinol or Kaneka-Q10.

Thanks, DreamStalker.
I do include exercise in my plan. I try to ride my real bike at least an hour a day and during that hour I try to get my heart rate up for a few minutes at a time. Pedaling against the wind on my cruiser sometimes gives me a pretty good work out. I do need to incorporate some resistive training.
I try not to over do it on the fruit and beans. Beans maybe once per week, if that, and a small bit of fruit daily. Most days my total carbs are under 50 grams. It looks like I get about 20% of my calories from carbs, 15% from protein, and 65% from fat or thereabouts. I continue to lose weight at about 1.5 lbs per week (21 lbs since the end of Feb), so I figure my caloric intake, fat/carb ratio are OK.
I did read your post in Good Calories, Bad Calories and have pretty much adopted your suggestions. I am working on getting my homones in balance with supplements and quarterly serum level tests (Vitamin D, B12, Thyroxine). I have brought these into the "normal" range.
I have put off taking niacin for a while, at least until I reduce my statin dosage. I'm going to monitor my HDL and see what happens with these changes in diet. So far, it's risen. But that may be just due to the rise in my serum cholesterol. If I drive my LDL down with statins, HDL might follow. If I become more concientious about exercise, per your suggestions, I may be able to keep it elevated without the niacin. Yet to be seen.
Again, thanks for your interest.

Jay