Hi Paddy, great piece. Very accessible for non specialists (like myself). What is the research telling us about the ability of statin therapy to address high cholesterol? Are they any downsides to statin therapy?
The answer as always is, it depends. And all those factors are what a good clinical consultation involves. It’s all about making bets. As you will understand I can’t give individual clinical advice here however. Unfortunately no certainties in this game.
Thank you for this article and all your writing! If I have had FH my whole life but only got on a statin at 45 (and now repatha), how do I understand my risk of a cardiovascular event? Would I have had incredibly high LDL since birth? Age 10? Age 20?
I'm so glad I found you on Twitter. Your blog posts are thorough yet accessible for laypeople. Do you have any thoughts on carotid artery ultrasounds? I have a CAC of 0, low blood pressure, low APOb and my Lp(a) is 11. My ldl is, unfortunately elevated (150s). The ultrasound showed a monophasic waveform but all other measurements were normal. Due to the waveform, the "indication" was severe CAD and a 10 year risk of 40 percent!!! Should I panic?
Love the article. Helps me learn. Two questions: 1) I hear a lot of APOB as a better predictor than LDL cholestorol. I assume the chart still applies? 2) Why wouldn't we put just about everyone (always some exceptions) on statins at a certain age, say 40, or 30?
Remember that Ference is a population graph (ecological), which does not generate individual inference. Nor does the particle accumulation theory have any strength because of this, otherwise it would be a strong predictor as well as a flow, and this fails to happen in very many cases.
Some people are disputing the role of high LDL when other markers (e.g. fasting insulin, HDL, triglycerides) are healthy. It would be nice to clear this up using some references to research.
Additionally, I wonder about the linear relationship between cholesterol and plaque and the relationship of risk over time - it feels like something is missing here. How does CAC score relate to this? From what I have seen a stable CAC score (even when relatively high) shows low risk of subsequent death - it's the increasing scores that are problematic. So does that imply that merely having high cholesterol isn't the root problem but that there's some other dysfunction makes the higher LDL levels lead to calcification?
Love your writing you are continually spot on. Reminded me of what my cardiologist friend quipped: You can never be too rich or have a too low LDL;)
Great article dr paddy food for thought
Love it doc and I love numbers.
More detail in few minutes reading than I’ve been able to get in 3 years from my GP or anyone talking at me.
Never mind just me, time to start taking the kids intake more seriously too.
Had to read the alcohol article first, naturally, but lots of reading tonight, only found you yesterday. Breath of fresh air.
Thanks
Hi Paddy, great piece. Very accessible for non specialists (like myself). What is the research telling us about the ability of statin therapy to address high cholesterol? Are they any downsides to statin therapy?
Very interested in having a discussion with my GP shortly
Thank you for this update and well informed information on taken control over my Owen flight path.😊
Great article Paddy and a refreshing take on risk accumulation + time. Great clarity.
The answer as always is, it depends. And all those factors are what a good clinical consultation involves. It’s all about making bets. As you will understand I can’t give individual clinical advice here however. Unfortunately no certainties in this game.
Thank you for this article and all your writing! If I have had FH my whole life but only got on a statin at 45 (and now repatha), how do I understand my risk of a cardiovascular event? Would I have had incredibly high LDL since birth? Age 10? Age 20?
I'm so glad I found you on Twitter. Your blog posts are thorough yet accessible for laypeople. Do you have any thoughts on carotid artery ultrasounds? I have a CAC of 0, low blood pressure, low APOb and my Lp(a) is 11. My ldl is, unfortunately elevated (150s). The ultrasound showed a monophasic waveform but all other measurements were normal. Due to the waveform, the "indication" was severe CAD and a 10 year risk of 40 percent!!! Should I panic?
Love the article. Helps me learn. Two questions: 1) I hear a lot of APOB as a better predictor than LDL cholestorol. I assume the chart still applies? 2) Why wouldn't we put just about everyone (always some exceptions) on statins at a certain age, say 40, or 30?
Is it possible to reduce the amount of plaque in your arteries?
Remember that Ference is a population graph (ecological), which does not generate individual inference. Nor does the particle accumulation theory have any strength because of this, otherwise it would be a strong predictor as well as a flow, and this fails to happen in very many cases.
Thanks for the article!
Some people are disputing the role of high LDL when other markers (e.g. fasting insulin, HDL, triglycerides) are healthy. It would be nice to clear this up using some references to research.
Additionally, I wonder about the linear relationship between cholesterol and plaque and the relationship of risk over time - it feels like something is missing here. How does CAC score relate to this? From what I have seen a stable CAC score (even when relatively high) shows low risk of subsequent death - it's the increasing scores that are problematic. So does that imply that merely having high cholesterol isn't the root problem but that there's some other dysfunction makes the higher LDL levels lead to calcification?