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Study: HDL, Triglycerides Better Markers For Cardiovascular Risk Than LDL

An article published at TheHeart.org today about a new study on the vital importance of measuring HDL and triglycerides instead of simply relying on the traditional Framingham risk score looking at LDL cholesterol particle size and numbers as predictors of the risk for a cardiovascular event should be an eye-opening moment for those in the medical community still living in the Ice Age with their medical knowledge.

Lead researcher Dr. Karim El Harchaoui, from the Academic Medical Center in Amsterdam, the Netherlands, along with his fellow researchers used a relatively new measuring technique called a nuclear magnetic resonance spectroscopy to see if LDL cholesterol could be connected with the risk for a future cardiovascular event in over 25,000 study participants who had moderately high LDL levels in the European Prospective Investigation into Cancer and Nutrition (aka the EPIC project) that took place from 1993-1999.

In all, Dr. El Harchaoui and his team looked at the 1,003 study participants who developed cardiovascular disease over the six-year study and compared them with 1,885 control subjects to predict the odds of having another cardiovascular event, specifically looking at the LDL particle count and size for measuring taking into account the HDL and triglyceride numbers.

What the researchers found was startling–LDL particle numbers and size were found to be no more predictive of cardiovascular risk than the often ignored HDL and triglyceride numbers. In other words, the general practice of most doctors to zero in on LDL cholesterol particle size and total number alone when assessing the risk for future coronary heart disease issues is outdated and should not longer be used, according to the researchers.

I ran into this very same thing personally last April when I visited my doctor and he expressed his concern about my LDL numbers coming back moderately elevated after using a traditional cholesterol test. When I explained to him how my triglyceride/HDL ratio was outstanding with readings of 72 and 42 respectively, his response back to me literally floored me.

Here’s what I wrote about that experience at the time:

He responded that while those numbers are good and my weight loss has been quite impressive, those are simply IRRELEVANT when you are talking about LDL as a separate measuring stick for the risk of heart disease. He acknowledged that most medical professionals give more weight to the LDL than they do HDL or triglycerides these days and that they want to see that LDL number go as low as possible regardless of what the other numbers are.

Seriously?! Is he kidding me? I’m not a doctor nor do I pretend to understand all the aspects of the cholesterol debate, but that seems just a bit shortsighted to me. Why even measure HDL or triglycerides if they aren’t as important as LDL, hmmm?

Rather than encouraging me with the incredible IMPROVEMENTS that I have seen in my HDL, my doctor dismisses these numbers and even ignores the total cholesterol/HDL ratio which at 3.5 is well within what is considered the “safe” range.

But, noooooooooooooo! It’s all about the LDL and nothing else. Yikes! Has it really come to THIS in the practice of medicine these days that we live in such a cookie cutter society that everyone must be treated exactly the same? Was losing 180 pounds not enough for ya, doc?

Now we have a study confirming it really is more than just about the LDL and that low-HDL and high triglycerides are a good predictor of a very high risk for cardiovascular disease. This is not good news for people who eat a high-carb diet since this recent study confirms consuming all those carbohydrates makes your HDL go way down and your triglycerides go way up.

Just in case you missed the message of all this so far, here’s a recap: Eating too many carbs lowers HDL and raises triglycerides. Having low-HDL and high triglycerides INCREASES your risk for coronary heart disease regardless of what your LDL cholesterol number is. Raising your HDL and lowering your triglycerides is tantamount to protecting yourself from any future cardiovascular event. Still with me? Keep reading…

Dr. Matthijs Boekholdt, one of the co-authors of the study also from the Academic Medical Center, said patients who have even a moderately elevated LDL cholesterol number should not be burdened with the expense of having something like the high-priced VAP test or the equally expensive Liposcience test (both are between $100-200 a pop!) conducted if their HDL is higher than normal and their triglycerides are below 100.

“Although it’s good to be aware of LDL, it’s expensive to test,” Dr. Boekholdt stated. “We show that HDL and triglycerides provide similar predictive information. Most doctors do not look at HDL or triglycerides because, unlike LDL, treatment for these parameters is not mainstream clinical practice. It would be more useful to be aware of these results, particularly in those with the metabolic syndrome, abdominal obesity, or diabetes.”

Boy, is he ever right! That was EXACTLY my experience when I tried to explain to my doctor about my good HDL and triglyceride numbers. But it was like talking to the wall because he would have nothing of it because my LDL was over 100. I’m thinking of printing out this new study and taking it down to my doctor tomorrow to help educate him about this subject, but I doubt he’ll take the time to read it or even care. What’s the use when so many in the medical community are oblivious to facts?!

The conclusion of the researchers is that doctors should stop using LDL levels to treat cardiovascular disease risk as a preventative measure. Uh-oh! What’s gonna happen to all these billions of dollars in television ads running for ads for cholesterol-lowering statin drugs like Crestor and Lipitor (both of which I have been on in the past before I started livin’ la vida low-carb) if news about this study gets out?

As if the pain of taking statin drugs wasn’t bad enough on its own, now we learn that having a moderately high LDL number is not so bad after all. How many people have added their share of dollars to the coffers of the pharmaceutical industry needlessly because of this trumped up cholesterol crisis we’ve been told we have, hmmm? It’s disgusting if you ask me!

What is most sad is doctors keep raising the doses higher and higher on these dangerous drugs despite the fact that there have been studies showing elevated LDL cholesterol levels can be good for you as you get older.

Are doctors even paying attention to all the relevant research that is coming out or are they simply relying on that pharmaceutical rep to tell them what’s out there? How much you wanna bet none of them will share this study about the importance of HDL and triglyceride levels in determining heart health risk?

Dr. Boekholdt said doctors
too often look at patients as a collective body using a one-size-fits-all mold rather than the personalized health needs of the individual. That means they should start observing not just the LDL, but also the HDL and triglycerides as part of the standard lipid test results.

“Most doctors tend to ignore abnormal HDL and triglyceride levels because there is not much you can do about them,” he explained.

Well, actually there is something you can do about abnormally low HDL levels and/or abnormally high triglycerides, Dr. Boekholdt. It’s called livin’ la vida low-carb. This simple, but effective dietary change has been shown to raise HDL levels without medication and be beneficial for overall cholesterol health, including significantly lowering triglyceride levels to below 100. That’s how you know when someone is doing low-carb the right way.

The fact is when you are on a low-carb diet, the traditional cholesterol results are irrelevant when you DON’T factor in the HDL and triglyceride numbers as well because these are VERY important in assessing the real risk for future heart health problems. I’m pleased to see the research is FINALLY catching up to reality.

Doctors may know about the risks associated with higher triglyceride levels, but they have not give that as much credence as the LDL cholesterol levels, the researchers contend.

Despite their negative view of LDL in the study, the researchers say it can still be a useful tool for doctors to help their patients understand the specific risks they face rather than simply relying on one test to determine treatment options for any cholesterol levels that are out of control. Even still, the VAP and Liposcience tests (interestingly, one of the co-authors of this study was a representative from Liposcience headquarters in North Carolina) are costly and sometimes difficult for the average person to access.

“At any given LDL level, if you have two people and one has increased LDL while the other has normal LDL, the one with the increased LDL is at greater risk of [a cardiovascular event, and this tends to coincide with people who have metabolic dyslipidemia [which usually includes low HDL-C levels and high triglycerides],” the researchers added.”

Get this! Even those people who have been put on one of those joint-jarring statin drugs may STILL be at an elevated risk for heart attack or stroke.

“There is some evidence that people treated with statins who achieve a good LDL level…remain at high risk,” Dr. Boekholdt explained.

WHOA! So much for those commercials with that freaky-looking heart surgeon who developed the artificial heart touting Lipitor as a healthy way to reduce the risk of heart disease. It looks like that’s yet another one of the big fat lies we’ve been hearing from the so-called health experts for far too long. Perhaps low-fat diet advocate Dr. Dean Ornish may want to change his tune about HDL cholesterol in light of this research. Don’t bank on it anytime soon!

This study was published in the January 22, 2007 issue of The Journal of the American College of Cardiology.

You can e-mail Dr. John J.P. Kastelein about this study at j.j.kastelein@amc.uva.nl.

  • Lady Atkins

    My trigs were 39 and my HDL was 82 at my last test. :)

  • Jimmy Moore

    You go, Lady Atkins! :D

    THAT’S AWESOME! I’ll have mine checked again soon, but I don’t want my doctor to be the one doing it. Isn’t that awful that I feel like I have to hide my health from my own doctor?!

    ARGH!

  • Kate Welch

    From what I’ve read, dietary intake of cholesterol has little effect on cholesterol levels (for example, eggs have long been vilified as evil cholesterol raising bullets, but Dr. Agatston’s research indicates otherwise).

    So Jimmy, any thoughts on where people without health insurance, or who, like you, don’t want to go to their own doctor, can go for these kinds of tests?

    Kate at The Steaks Are High

  • Jimmy Moore

    You are exactly right, Kate. Dietary cholesterol does NOT (I REPEAT!) does NOT raise your blood cholesterol levels as has been often theorized by the so-called experts fooling the uneducated into taking dangerous and expensive statin drugs.

    The truth is slowing seeping into parts of our culture, but it hasn’t hit the mainstream. Cholesterol tests like VAP and Liposcience are too costly for most people and insurance doesn’t cover them. Unfortunately, you usually have to go through a doctor to administer them.

    What we need is a nationwide database of low-carb friendly doctors we can access. Nobody has created such a list, but it is SORELY needed.

  • renegadediabetic

    Jimmy, I know how you feel about not wanting your doctor to check your cholesterol. For me, as a diabetic, they are even more obsessive about it. My LDLs were high and my HDLs low when I was first diagnosed. About a month later, my LDLs were lower, but not low enough and my doctor said Lipitor. However, I ran into people who had bad reactions to Lipitor. When I researched it, I found even more side effects to Lipitor that the medical establishment doesn’t like to acknowledge. Needless to say, I didn’t get the prescription filled. It was also about that time I came to my senses on low carb. I had to eventually face my doctor again. We checked it again and my LDLs were 101 with improved HDLs. I know it will be checked periodically and I am concerned about it creeping up too much so that the S-word is mentioned again.

    They are so fixated on cholesterol that they miss other risk factors, such as high blood sugar (even at levels that the medical establishment calls “normal”), high insulin levels, etc. There are those who say that all diabetics should be on statins and that diabetics should get their LDL cholesterol even lower than 100. It has more to do with selling drugs than with health.

  • Lady Atkins

    I don’t know, Jimmy. Like you, my cholesterol went way up eating low-carb (both HDL and LDL went up). I suspect eggs are the culprit in my case so I’ve cut back how many I eat.

  • Robin

    Just want to note that I eat a high (good) carb diet (60% carbs), and my trigs have dropped by HALF to 56, and HDL has remained high at 67. LDL also dropped by about 10 pts.

  • Jimmy Moore

    CONGRATULATIONS, Robin! I bet you feel awesome with that diet and I’m proud of you for your success. :D

  • Blaise

    I strongly agree that triglyceride levels have been sadly underestimated (and outright ignored) in predicting damage to one’s health. AND it’s actually CRIMINAL how many health professionals push “low-fat” diets and bad-mouth “low-sugar-and-starch” diets. Do they think that the human body cannot turn sugar and long-chain-sugars (= starches) into
    fats. Where were they in junior high school and high school health/biology/chemistry classes?

    I would like to refer you to this web link

    http://people.subdude-site.com/WebPicsBlaise/DATA4Blaise/BlaiseBloodStats/bloodstats_blaise.htm

    where I actually correlate triglyceride levels with 3 or 4 different unhealthy conditions.

    I unintentionally turned myself into a “sugar guinea pig” (a medical experiment).

    It should not be hard for health researchers to find people to volunteer their blood test records and general descriptions of their medical problems (similar to my descriptions) and thus generate
    significant research papers at very low-cost — way lower costs than the costs pharmaceutical companies are incurring to synthesize, search-for-data-on-benefits (but not side-effects), clinically-justify, lobby-for, and market still more cholesterol drugs.

    By doing such research, they can turn my “anecdotal evidence” into
    “evidence-based research”.