Excellent write-up. We need those who have very high cholesterol to up the fiber in their diet. And eat fish weekly. In the U.S. some supplements are not pure.
I was surprised that there was no mention here of the value (or not) of reducing one's consumption of saturated fat. For those with high LDL numbers and whose regular diet includes high amounts of saturated fat, is that not a sensible thing to try?
Absolutely a sensible thing to try. The dietary approach to cholesterol is an entirely separate piece and this was more focused on non prescription approaches but yes reducing Sat fat can make a difference.
Looking forward to the article on diet and potential to reduce cholesterol. Cant really find clear advice on this. Reduce saturated fat, yes, but no specific guidance, and lots of stuff about eating almonds etc. Hoping you can give the definitive summary.
Lots of potential to do so with reducing saturated fat and some other approaches but my take is that very few get to the lower bound target needed without some form of pharmacotherapy. Its a reasonable thing to do but I often find is insufficient.
I'm not convinced that LDL is a cause of CAD or not, but I'm also not convinced that low LDL and taking statins is bad for me. Thus, I take my meds and my lipid numbers are stellar.
I sure tried, with 2 different statins, but quickly felt ill and very foggy. Couldn’t function well at work or even feel safe driving. So, that’s a “no” for me.
It all depends on time frames. If you are 80 years old with no plaque and high LDL then the utility of lowering is obviously less. But if you are younger then it's still a role of the dice. Regardless it does mean that your very near term risk is likely to be low.
Peoples responses are very varied. In general lowering sat fats will lower LDL-C but experimenting with this in the context of a nutrition strategy is a sensible thing to do.
You are correct that the number of lipoproteins (APOB) is the best indicator of risk but it is their cholesterol cargo that causes the problem. Not the actual APOB protein.
They found ‘a surprisingly weak and inconsistent relationship between the degree of reduction in LDL cholesterol from taking statins and a person’s chance of having a heart attack or stroke’.
The effect of taking statins: ‘absolute risk reduction of dying, having a heart attack or stroke was 0.8%, 1.3% and 0.4% respectively.’
It’s all about time frames. Over a 5 year period the risk reduction is small. Over the time however horizon you are really interested in, ie the rest of your life, the differences are much larger.
The literature on Berberine shows quite a variable response and I suspect it’s ‘poor man’s PCSK9’ status is driven by whether someone may have one of these gene mutations and derive a big response. For others they have minimal response.
Excellent write-up. We need those who have very high cholesterol to up the fiber in their diet. And eat fish weekly. In the U.S. some supplements are not pure.
Thoughts RE: neg coronary artery calcium scan in face of skewed lipid profile?
The answer as always is - it depends. This is something I will be writing about in a future article.
I was surprised that there was no mention here of the value (or not) of reducing one's consumption of saturated fat. For those with high LDL numbers and whose regular diet includes high amounts of saturated fat, is that not a sensible thing to try?
Absolutely a sensible thing to try. The dietary approach to cholesterol is an entirely separate piece and this was more focused on non prescription approaches but yes reducing Sat fat can make a difference.
Looking forward to the article on diet and potential to reduce cholesterol. Cant really find clear advice on this. Reduce saturated fat, yes, but no specific guidance, and lots of stuff about eating almonds etc. Hoping you can give the definitive summary.
Lots of potential to do so with reducing saturated fat and some other approaches but my take is that very few get to the lower bound target needed without some form of pharmacotherapy. Its a reasonable thing to do but I often find is insufficient.
I'm not convinced that LDL is a cause of CAD or not, but I'm also not convinced that low LDL and taking statins is bad for me. Thus, I take my meds and my lipid numbers are stellar.
I sure tried, with 2 different statins, but quickly felt ill and very foggy. Couldn’t function well at work or even feel safe driving. So, that’s a “no” for me.
Thankfully there are more options than statin therapy available.
Curious which two you tried, Kitty. I was foggy on Atorvastatin, but am doing well on Rosuvastatin.
Started with Rosuvastatin, really impactful, and then simvastatin which I cut in half. Still no good.
I was expecting Plant Sterols like Benecol to be included in the article. Do you think they work?
My LDL for the first time is raised 2.95 mmol/L, Triglyceride 0.68 mmol/L,
HDL 2.76 mmol/L , Non-HDL 3.26
mmol/L
T.Chol/HDL Ratio 2.18
I have started taking Benecol - I did not know about the other options you mention here.
In your opinion are they a better choice than Benecol?
Thank you .
They have been shown to modestly lower cholesterol. The question for all of us is our lower target and that depends on many factors.
What if you have high LDL and no evidence of arterial plaques?
It all depends on time frames. If you are 80 years old with no plaque and high LDL then the utility of lowering is obviously less. But if you are younger then it's still a role of the dice. Regardless it does mean that your very near term risk is likely to be low.
Thank you. I’m 61.
And am unable to tolerate statins.
What's your opinion on carbohydrate contribution to high cholesterol versus dairy and animal fats?
Peoples responses are very varied. In general lowering sat fats will lower LDL-C but experimenting with this in the context of a nutrition strategy is a sensible thing to do.
Thank you. Would it be worth getting a lipid genetic profile blood work to identify PCSK9 as it seems one size does not fit all ?
You say "The evidence that high LDL cholesterol CAUSES coronary artery disease is overwhelmingly clear"
I thought the number of lipoproteins was the cause (apob), not their content. Or is it beign too nit-picky ?
You are correct that the number of lipoproteins (APOB) is the best indicator of risk but it is their cholesterol cargo that causes the problem. Not the actual APOB protein.
Very helpful piece.
I’ve been influenced by this:
https://theconversation.com/benefits-of-statins-may-have-been-overstated-new-study-175557
They found ‘a surprisingly weak and inconsistent relationship between the degree of reduction in LDL cholesterol from taking statins and a person’s chance of having a heart attack or stroke’.
The effect of taking statins: ‘absolute risk reduction of dying, having a heart attack or stroke was 0.8%, 1.3% and 0.4% respectively.’
What’s your take on that?
It’s all about time frames. Over a 5 year period the risk reduction is small. Over the time however horizon you are really interested in, ie the rest of your life, the differences are much larger.
Have you seen anything on combining a statin with Berberine? Sort of a poor man’s pcsk9 inhibitor?
The literature on Berberine shows quite a variable response and I suspect it’s ‘poor man’s PCSK9’ status is driven by whether someone may have one of these gene mutations and derive a big response. For others they have minimal response.