The Cholesterol Thread: HDL v. LDL v. Lipitor - CAGEMATCH

[GoldMember]

My latest results, May, 2023:

Me - 67, 5'-10", 175 lbs
Atorvastatin 10 mg and 100 mg CoQ10

Total Cholosteral - 159
Triglycerides - 81
HDL - 58
LDL (calculated) - 87
Chol/HDL - 2.8

Doc originally started me on 20 mg of Zocor about 22 years ago. I had a thallium treadmill test and showed no blockage but my cholosteral was a bit high, right around 220 so he wanted me on statins, which I reluctantly agreed to. After about a year, I quit taking them due to muscle aches and the news around that. I saw him again a few months later which is when he put me on Atorvastatin and CoQ10. I've had no issues since over the past 20 years and my numbers have been pretty similar to what I just put up. I have no complaints with this as it's worked well. No special diets, either. FWIW,

[MagnificentUnicorn]

My understanding is that apolipoprotein B, which is a component of LDL, is the primary bad guy. LDL and ApoB are correlated, so LDL is a decent biomarker on average, but ApoB is what actually causes ASCVD.

https://pubmed.ncbi.nlm.nih.gov/31642874/
https://peterattiamd.com/measuring-c...f-apob-part-1/

It’s more complicated than that. I’m just learning about this, it’s really interesting. The common lab value of LDL is calculated (LDL-C) and apoB is a component. However a real measured value is LDL-P(actual measured LDL particles) You can have a high LDL value in a blood serum cholesterol test but if you don’t know the LDL-P value it’s really not helpful in determining risk for atherosclerosis. You can have high LDL-C and a low LDL-P value and be at low risk for atherosclerosis. Of course there’s an entire spectrum of concordant and discordant values that determine you real risk for atherosclerosis. I’m sure I’m not explaining this well.

I would suggest reading the Peter Attia series of articles that I linked earlier. I generally don’t care for him but that series of articles is just explaining what cholesterol is, what it does in our bodies(all types of cholesterol are essential for cell function), how it is synthesized in our bodies, how it moves around our bodies, how it affects atherosclerosis etc. He laying out in easily understandable terms what he’s learned from the people on the forefront of lipidology. It’s really interesting.

We’re kind of behind in the US when it comes to understanding cholesterol and utilizing meaningful testing for risk. Most people never get tested for apoB or NMR testing for LDL-C.

I didn’t look at the links you posted, you may have already read the information that I linked.

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[phatty]

I think it was something like 3.6% in the control group (no statins) had a heart attack while 1.7% that took statins still had heart attacks. So if analyzed over the entire group, there was a 1.9% difference. The weird thing was that the latter analysis is applied to side effects to statins, so that's inconsistent.

That's what my primary care doc told me when I went off statins years ago after the side effects. I was early 30s at the time and in good shape. He said statins would reduce my risk of dying from heart issues, but not significantly enough to stay on them. He said that if he were in my shoes, he'd get off them.

Now that I have had a heart attack, I'll use them as the downside is low. Plus it would stress my wife to no end if I didn't. Not worth it it.

[Buster Highmen]

I misquoted:

The study of 10304 high risk for heart attack people.

Half were given a statin, half a placebo.

1.9% of the statin group had a heart attack.
3.0% in the control group (no statin) had a heart attack.

So, overall, the statin reduced HAs by 1.1% relative to the entire study.

But the wider known representation is 36% which is 1.9/3.0, a relative comparison.

https://www.researchgate.net/publica...rrative_review ..


If the CT scan shows any plaque, I'll likely start on statins.

[Buster Highmen]

Coronary CT scan results:
CALCIUM SCORE:
LM: 0
LAD: 0
LCX: 0
RCA: 0
Total: 0


>>>>>>>>>>>>>>>>>>>>>>>

A person living with high levels of cholesterol could still have a CAC score of zero. In most cases, a person who receives a score of zero has a reduced risk of developing heart disease.

The American College of Cardiology Foundation’s (ACCF’s) 2018 guidelines indicate that a person who receives a zero CAC score does not need to take statins immediately. They only advise those with a zero CAC score to take statins if they:

smoke
have diabetes
have a family history of coronary artery disease
What does a zero score mean?
A CAC score of zero meansTrusted Source that the CT scan of the heart did not reveal a buildup of calcified plaque in the blood vessels leading into the heart. As a result, the person has a low risk of developing heart disease or experiencing cardiovascular events such as a heart attack.

Do I need statins if my calcium score is zero?
The American Heart Association (AHA)Trusted Source and several studies have concluded that a CAC score of zero means a person can typically avoid taking statins for cholesterol. People with a score of zero have a low risk of developing heart disease.

from: https://www.medicalnewstoday.com/art...-score-of-zero

[Hopeless Sinner]

Coronary CT scan results:
CALCIUM SCORE:
LM: 0
LAD: 0
LCX: 0
RCA: 0
Total: 0

Sweet!!!

[old goat]

I thought this was an impressive read, well founded in biochemistry .
https://www.amazon.com/Clot-Thickens.../dp/1907797769




So, is this more clickbait?

One of the articles I read addresses the claim that statins have a 25% reduction in HAs .

The claim is that %age is with regard to the number of people that had heart attacks in the study group, not the total number of people in the study.

I think it was something like 3.6% in the control group (no statins) had a heart attack while 1.7% that took statins still had heart attacks. So if analyzed over the entire group, there was a 1.9% difference. The weird thing was that the latter analysis is applied to side effects to statins, so that's inconsistent.

Can anyone corroborate that? If that stat is valid, it makes me even more suspicious since the 25% is such a significant portion and a great sales pitch.

I do apologize OG if I offended you in my anti doctor rant years ago. At that time, I was fighting with my dad's negligent doctors who had him on warfrin and aspirin when he was passing out from internal stomach hemorrhaging and getting transfusions monthly. I think there were about 6 instances, he always hid them from me. After repeatedly failing to cauterize the ulcers, I forced his doctors to send him to the Mayo in Jacksonville where people with skillz fixed him. He eventually died of a stroke, possibly related to the thinners.

I've had other issues with health care when I needed doctors references (according to a neurosurgeon) and they refused. It's not the individual, it's the industry.

I haven't read the book so I won't comment. As for the article, it's not surprising that if you get to 75 and are healthy--ie no CV disease--your risk of dying of a heart attack or CV disease is too low to benefit from statins.
No offense was taken and I don't remember the thread. I've seen plenty of bad medicine and I'm certainly no fan of the medical industry in the US today, for a lot of reasons.

52yo, 6'1", 180lb

Total chol: 149
Triglyc: 90
HDL: 71
LDL: 61
VLDL: 17

PA says come back next year. Not sure I trust them quacks. Am I gonna die?

What's your family history? Did you or do you smoke? High blood pressure? Blood sugar? The lipid numbers have to be looked at as part of the overall risk profile. (And don't tell me; I'm not that kind of doc.)

I misquoted:

The study of 10304 high risk for heart attack people.

Half were given a statin, half a placebo.

1.9% of the statin group had a heart attack.
3.0% in the control group (no statin) had a heart attack.

So, overall, the statin reduced HAs by 1.1% relative to the entire study.

But the wider known representation is 36% which is 1.9/3.0, a relative comparison.

https://www.researchgate.net/publica...rrative_review ..


If the CT scan shows any plaque, I'll likely start on statins.

The difference between absolute risk reduction and relative risk reduction is important when deciding when to put a large population of people on a treatment. I don't like relative risk reduction in this context; it's commonly used to make results more impressive than they are, both in the popular press and in scientific journals.

For the record--I have a terrible family history and high blood pressure. I had angina and had a 3 artery bypass when they fixed my aneurysm and aortic valve. I've had muscle pain on statins and am currently on ezetimibe and Repatha with good chemical results. I still have muscle pain, so maybe I should go back on statins.

[Buster Highmen]

I haven't read the book so I won't comment. As for the article, it's not surprising that if you get to 75 and are healthy--ie no CV disease--your risk of dying of a heart attack or CV disease is too low to benefit from statins.
No offense was taken and I don't remember the thread. I've seen plenty of bad medicine and I'm certainly no fan of the medical industry in the US today, for a lot of reasons.


What's your family history? Did you or do you smoke? High blood pressure? Blood sugar? The lipid numbers have to be looked at as part of the overall risk profile. (And don't tell me; I'm not that kind of doc.)

Smoked cigs from 20 to 40. Now just a weekly puff or 2 of weed. Last bp at office was 125/80, at home it's more like 120/75. Triglycerides at 127. Current doc at my HMO knows all this but is still pushing for statins with my LDL of 200 and HDL of 70. Maybe now the CCT of 0 will get him to reconsider. I'm still on the fence about taking them, slowly teetering back to not taking them.

The difference between absolute risk reduction and relative risk reduction is important when deciding when to put a large population of people on a treatment. I don't like relative risk reduction in this context; it's commonly used to make results more impressive than they are, both in the popular press and in scientific journals.

Yep, really screws up my faith in the product and industry.

For the record--I have a terrible family history and high blood pressure. I had angina and had a 3 artery bypass when they fixed my aneurysm and aortic valve. I've had muscle pain on statins and am currently on ezetimibe and Repatha with good chemical results. I still have muscle pain, so maybe I should go back on statins.

Sorry to read that. Good luck, may you feel better.

[old goat]

Sorry to read that. Good luck, may you feel better.

No need to feel sorry. I feel pretty damn good overall. I can still ski. And the main reason for my muscle pain is probably laziness and a knee that's started to cut into my hiking, but mainly laziness.

[SumJongGuy]

5'8" 185 pounds
Pre 10 mg statin
Cholesterol, Total 214 mg/dL
LDL Calculated 148 mg/dL
HDL 35 mg/dL
Triglyceride 157 mg/dL

Post 10 mg statin
Cholesterol, Total 140 mg/dL
LDL Calculated 87 mg/dL
HDL 35 mg/dL
Triglyceride 90 mg/dL

My A1C is still right at 5.7.. right where they've moved the goal posts since I started eating a little better. I think it peaked at 5.8 for me two years ago when the goal posts were at 6.

[Dantheman]

It’s more complicated than that.

It's always more complicated. Unbelievably, mind-bogglingly complicated

Anyone who claims to have this all figured out is not to be trusted. But, if we're going to reference Attia, based on his articles that I've read and the various podcast episodes I've listened to, I feel pretty confident saying that if he had to pick one easily measurable biomarker to hang your hat on for ASCVD risk it would be ApoB.

[PB]

This is important. Most heart attacks are caused by the sudden rupture of relatively small plaques. When you have bad plaques that mostly block the artery the heart develops collateral circulation that bypasses the blockage as the plaque grows, so that part of the heart is protected from a heart attack. That's why bypassing the heart arteries or stenting them open doesn't reduce the risk of heart attack--those procedures aren't targeting the plaques that cause heart attack.


Anyone looking for a reason to avoid lipid lowering drugs, or vaccines, or anything else medical can always find support somewhere in this age of podcasts and blogs. Contrarian opinions get clicks; orthodox opinions don't.


The benefit of statins was proven before coronary calcium scans were available. There is some evidence that people with higher ccs's may benefit more from statins but that doesn't mean people with low scores don't benefit. Whether or not someone gets statins should still be based on overall risk factors; a high ccs may be of benefit primarily to convince a patient or a patient's doctor to take a statin. Besides the fact that dangerous plaques may not have calcium, the benefits of statins in a person with moderate to high risk but low ccs plays out over time--especially for younger patients the statins will prevent the buildup of plaque in arteries that are clean today but won't be tomorrow.

Good info - thanks!

[MagnificentUnicorn]

It's always more complicated. Unbelievably, mind-bogglingly complicated

Anyone who claims to have this all figured out is not to be trusted. But, if we're going to reference Attia, based on his articles that I've read and the various podcast episodes I've listened to, I feel pretty confident saying that if he had to pick one easily measurable biomarker to hang your hat on for ASCVD risk it would be ApoB.

For sure. Attia doesn’t claim to have it figured out in regards to cholesterol, he’s sure to make it clear that he’s conveying information from his mentors and others on the forefront of lipidology


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[old goat]

It's always more complicated. Unbelievably, mind-bogglingly complicated

Anyone who claims to have this all figured out is not to be trusted.

Yep.

[fomofo]

More fuel for the fire, FWIW.

A controversial study has argued that if you have a high LDL (bad) cholesterol level when you are aged over 60, you will live longer, there is no increased risk of cardiovascular disease and that statins will have little effect. But can we trust these bold claims?

https://www.bhf.org.uk/informationsu...ol-and-statins

This embedded in article...

https://www.bhf.org.uk/informationsu...your-heart-age

[Eastside]

56yom. I have a family history of high cholesterol. When I was in perfect physical shape and ate perfectly, total was still not great I have refused to take statins for all that time for all the reasons, Drs. are paid shills, rando chiropractors suggest anus tanning, etc... I recently had a cardiac calcium store. I am now on statins.

[Dantheman]

More fuel for the fire, FWIW.

A controversial study has argued that if you have a high LDL (bad) cholesterol level when you are aged over 60, you will live longer, there is no increased risk of cardiovascular disease and that statins will have little effect. But can we trust these bold claims?

https://www.bhf.org.uk/informationsu...ol-and-statins

This embedded in article...

https://www.bhf.org.uk/informationsu...your-heart-age

Mendelian randomization studies would like a word.

[XXX-er]

somewhere around 50 the pro gave me a stern talking to, told me " we don't say type II anymore you are just diabetic "

ok so I never had a really bad diet but mayeb i should do something to get the pro to quit bugging me and the easiest thing was to eat 40% LESS / quit using any added sugar including honey/ read the white label to pick foods that have less sugar

I lost about 15lbs in < 6 months to a normal BMI, a1C went from around 9 to around 7, good cholestral went up and bad cholestral went down so I was medicaly speaking a big win for the pro so she has mostly quit bugging me, she was on about the metformin bu that aint gona happen and whenever i see her its usually skiing or mtn biking

[bigdude2468]

The latest thinking is there is no LDL level too low. Europe has been doing this for a few years and recently this has become the mantra from many US cardiologists. Adding Ezetimibe along with a statin typically lowers LDL by another 20%.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7355098/

[old goat]

BMJ is a very respected, peer reviewed journal so the article has to be taken seriously. It would be interesting to see if there are any editorials about it in the BMJ or other peer reviewed journals. There is a tool--Scopus--that allows you to search for articles citing the article in question but I'm not willing to open an account. Maybe someone here has access and is less lazy than I am and can look it up.

There are two kinds of responses to articles like this--knee jerk responses citing the conventional wisdom and serious statistical and scientific analysis. Only the latter is to be trusted.

[bigdude2468]

Another article that sites several studies that lower is better, this from the Journal of the American College of Cardiology.

https://www.jacc.org/doi/10.1016/j.jacc.2020.03.033

[fomofo]

56yom. I have a family history of high cholesterol. When I was in perfect physical shape and ate perfectly, total was still not great I have refused to take statins for all that time for all the reasons, Drs. are paid shills, rando chiropractors suggest anus tanning, etc... I recently had a cardiac calcium store. I am now on statins.

What is a "cardiac calcium store" / what did you mean to type?

Also, what has your experience been being on statins? Any side effects? Have your levels come down significantly?

[zion zig zag]

Better question is what was your calcium score? How high was it to convince you to go on statins right away?


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[yeahman]

Is it really possible to have clogged artieries and have no symptoms like shortness of breath, high blood pressure, elevated heart beat, etc.?

[PB]

Depends on exactly which arteries .......