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Cholesterol and Statins

I think this paper is relevant. As regards whether to take statins - damned if you do, damned if you don't
www.ncbi.nlm.nih.gov

Small Dense LDL: Scientific Background, Clinical Relevance, and Recent Evidence Still a Risk Even with ‘Normal’ LDL-C Levels

Residual cardiovascular disease event risk, following statin use and low-density lipoprotein cholesterol (LDL-C) reduction, remains an important and common medical conundrum. Identifying patients with significant residual risk, despite statin drug use, ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
Donnadoobie said:
That too full on for me to read, don’t understand what it is trying to say. I am a it ignorant when it comes to medical papers.
Click to expand...
Just looking at the abstract (summary) in a nutshell it’s saying it matters what type of ldl you have for the risks you face.

The conclusion says small, dense LDL particles are the risky one and can’t be identified by standard testing but are significantly present in people with chronic heart disease. They are strongly increased by lifestyle choices. Treatment
includes reduction of excess body fat, avoidance of simple carbohydrates in the diet, exercise, niacin (b3), fibric acid derivatives (medication) and omega-3 fish oil. Note that b3 has upper limits to take and has potential side effects and interactions so don’t just pop pills Willy nilly without detailed knowledge.
 
Donnadoobie said:
That too full on for me to read, don’t understand what it is trying to say. I am a it ignorant when it comes to medical papers.
Click to expand...
This is the crux of the matter, and what the report is demonstrating
"Despite significant, medication induced reduction in low density lipoprotein-cholesterol (LDL-C), a large reservoir of cardiovascular disease risk remains. The often quoted 25% relative risk reduction, attributed to LDL-C reduction, is actually only a 3.4% absolute risk reduction"
It is saying that despite LDL reductions (i.e. through statin medication et al) there remains a sizeable proportion of the population who are still at significant risk of heart disease or stroke, and that the claims for 25% reduction by the statin makers actually comes out at being more like 3%
 
HSSS said:
Just looking at the abstract (summary) in a nutshell it’s saying it matters what type of ldl you have for the risks you face.

The conclusion says small, dense LDL particles are the risky one and can’t be identified by standard testing but are significantly present in people with chronic heart disease. They are strongly increased by lifestyle choices. Treatment
includes reduction of excess body fat, avoidance of simple carbohydrates in the diet, exercise, niacin (b3), fibric acid derivatives (medication) and omega-3 fish oil. Note that b3 has upper limits to take and has potential side effects and interactions so don’t just pop pills Willy nilly without detailed knowledge.
Click to expand...
I can see you did read the paper. Thank you for the explanation. There is a test now for sdLDL-c. It uses the standard lab blood analyser equipment, but uses a different enzyme so that only the sdLDL is seperated out for measurement. so the test could be done like they are done now, but the TG test using this enzyme instead would give TG a new and meaningful marker for CVD. But the presence and significance of sdLDL is disputed by mainstream medicine and pharma so it will not happen overnight.

Also since the LDL portion of the blood lipid panel is estimated by subtracting the current TG from the total TC measured value along with the measured HDL value, then they will need to change the magic formula used. Its incorrect anyway, and needs changing already, but there is a major stumbling block to making it more accurate. HCP's understand the current system, so changing it would be major upheaval in healthcare.
 
Oldvatr said:
I can see you did read the paper. Thank you for the explanation. There is a test now for sdLDL-c. It uses the standard lab blood analyser equipment, but uses a different enzyme so that only the sdLDL is seperated out for measurement. so the test could be done like they are done now, but the TG test using this enzyme instead would give TG a new and meaningful marker for CVD. But the presence and significance of sdLDL is disputed by mainstream medicine and pharma so it will not happen overnight.

Also since the LDL portion of the blood lipid panel is estimated by subtracting the current TG from the total TC measured value along with the measured HDL value, then they will need to change the magic formula used. Its incorrect anyway, and needs changing already, but there is a major stumbling block to making it more accurate. HCP's understand the current system, so changing it would be major upheaval in healthcare.
Click to expand...
When I said it can’t be identified I should have said isn’t identified. Entirely agreed the current calculated ldl makes assumptions that are often inaccurate. Pretty much all fundamental changes in healthcare are slow especially for something pushed as hard as fats/cholesterol/statins. They need to also find a way to about face without losing face.

I’m not so sure HCP’s do all understand it. More than one have glazed over and looked totally lost when trying to discuss more than the very basics or the tick box limits of cholesterol. Trig/Hdl ratios, ldl particle size and assumptions not calculations conversations are typically shut down rapidly.
 
HSSS said:
When I said it can’t be identified I should have said isn’t identified. Entirely agreed the current calculated ldl makes assumptions that are often inaccurate. Pretty much all fundamental changes in healthcare are slow especially for something pushed as hard as fats/cholesterol/statins. They need to also find a way to about face without losing face.

I’m not so sure HCP’s do all understand it. More than one have glazed over and looked totally lost when trying to discuss more than the very basics or the tick box limits of cholesterol. Trig/Hdl ratios, ldl particle size and assumptions not calculations conversations are typically shut down rapidly.
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I said that they understand the system, not the process. Big difference there. They know which boxes need ticking, and what to prescribe if they fail to meet the guidelines. My GP covinced me that LDL is also measured, since he knows they put the sample in the machine, and it spits out the results a short while later. I have since found the Friedland Formula, and one of my drinking buddies has a son who works in the local hospital Lab doing these tests. Ergo its estimated. So changing the formula means changing the machine.
 
I’ve watched Dr Paul Mason quite a few times discussing statins on Low Carb Down Under. Thanks for the link @ianf0ster
I had a discussion, or tried to, a few years ago when my GP wanted me to take statins. I explained the percentages quoted by big pharma were ‘fudged’ and he ought to do just a bit of up to date research. His response was “I haven’t got time’ :rolleyes:

just editing to say I’ve just watch the YouTube video - WOW! I encourage you all to watch it. Thank again @ianf0ster
 
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Oldvatr said:
This is the crux of the matter, and what the report is demonstrating
"Despite significant, medication induced reduction in low density lipoprotein-cholesterol (LDL-C), a large reservoir of cardiovascular disease risk remains. The often quoted 25% relative risk reduction, attributed to LDL-C reduction, is actually only a 3.4% absolute risk reduction"
It is saying that despite LDL reductions (i.e. through statin medication et al) there remains a sizeable proportion of the population who are still at significant risk of heart disease or stroke, and that the claims for 25% reduction by the statin makers actually comes out at being more like 3%
Click to expand...
No, it's not saying the 25% reduction is anything other than what it is. The 'claims' by the statin makers are valid, proven over and over in trial after trial. 'Only' 3.4% absolute risk reduction demonstrated in a say a 5 year clinical trial is a lot. It's huge, considering that cardiovascular disease is the #1 cause of death in the world and the length of the clinical trials. Here's a reasonably good video which ends with a long and detailed explanation of absolute risk vs. relative risk as relates to clinical trials and statins.

 
HairySmurf said:
No, it's not saying the 25% reduction is anything other than what it is. The 'claims' by the statin makers are valid, proven over and over in trial after trial. 'Only' 3.4% absolute risk reduction demonstrated in a say a 5 year clinical trial is a lot. It's huge, considering that cardiovascular disease is the #1 cause of death in the world and the length of the clinical trials. Here's a reasonably good video which ends with a long and detailed explanation of absolute risk vs. relative risk as relates to clinical trials and statins.

Click to expand...
There won’t be a response to this from oldvatr as he passed recently.
 
I'm very disappointed to find that my non statin has the same side effects as a statin!!
Now I've had to stop my exercise and nearly nightly am up to take tylenol 1s. For the pain and stiffness it causes.
 
Can someone explain how they arrive at cholesterol numbers like 7.8 or 8.0? I‘m in the US and cholesterol levels here are normally read as Total Cholesterol 150. Is there a separate blood test in Europe?
 
Prancy said:
Can someone explain how they arrive at cholesterol numbers like 7.8 or 8.0? I‘m in the US and cholesterol levels here are normally read as Total Cholesterol 150. Is there a separate blood test in Europe?
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In the UK and Ireland the numbers are expressed in mmol/L while in the US they're in mg/dL. The blood tests are the same but give the results using a different unit of measurement. If you Google 'convert cholesterol calculator' you'll find some websites that will convert between units for you if required. One point to note is that conversion for triglycerides is different to the one for cholesterol - I have no idea why - all it means is you can't use a cholesterol converter for triglyceride numbers and vice versa.
 
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