LDL Measurements and Statin Use Poll

[sengsational]

Last time I went for my annual physical, I tried to get my doctor to run an advanced version of the lipid profile that exposed more detail about what the particle sizes were for my LDL concentration. He didn't want to do it because insurance wouldn't pay (that's a separate discussion), so I didn't argue and so I don't have that result. But I'm scheduling this year's visit, and am going to try again, since last time my LDL was considered to be less than optimal, and knowing the particle sizes would help to understand if action needs to be taken or not.

Anyway, I was curious as to how the smart people on this board have managed this LDL measurement thing for themselves. For me, my calculated LDL is above "where it should be". But I question the value of the calculated LDL that comes in the standard lipid panel. That's based on some well-respected studies I've read (I'll dig those up later, if needed), where lots of folks with "normal" LDL had cardiac events, and lots of people with "high" LDL were fine.

The analogy I think of with LDL is, just because you have 100 tons of LDL on boats, you really need to know what kind of boats you have. Do you have 10 barges with 10 tons each, or do you have 100 PT boats with 1 ton each. Those PT boats drive straight into the artery wall and "boom", you're in trouble!

[Sarah S]

Do you know your triglyceride level? There is research showing those with higher ldl but tg below 70 have the better LDL particles and those over 140 tg have the bad kind so you can decide treatment for those people with confidence without the particle size test if you are in the 70-140 range you might argue for the test

[Helen]

My doctor kept trying to get me to take a statin. I finally said if she tested me for the LDL type I would reconsider (but doubt I would have taken the statin). My LDL is made up of more of the large less harmful LDL.

I had read about the different LDL types, my doctor didn't tell me about it.

After 8 weeks on a vegan diet, I am going in next week to have my cholesterol tested again.

[heeyy_joe]

I read recently that vitamin B-3 reduces cholesterol. Anybody up on that?

[sengsational]

Quote:

Originally Posted by Nikki J Do you know your triglyceride level? There is research showing those with higher ldl but tg below 70 have the better LDL particles and those over 140 tg have the bad kind so you can decide treatment for those people with confidence without the particle size test if you are in the 70-140 range you might argue for the test

Yes, I did read something about how TG and HDL readings can be used as a predictor of LDL particle size. Using those values as a proxy, I'm in pretty good shape, which is why, even though my LDL-C not low, I've felt justified in my not taking statins. What I read, though, is that those other values as a proxy are not always on target. I think that works pretty well in a person with metabolic syndrome ("normal" LDL-C, but high TG and low HDL), but that's not me.

[sengsational]

Quote:

Originally Posted by Helen My doctor kept trying to get me to take a statin. I finally said if she tested me for the LDL type I would reconsider (but doubt I would have taken the statin). My LDL is made up of more of the large less harmful LDL. I had read about the different LDL types, my doctor didn't tell me about it. After 8 weeks on a vegan diet, I am going in next week to have my cholesterol tested again.

I'm curious...how did you pick 8 weeks? I've made diet and exercise choices, and wonder how long it will take to alter the lipid profile.

[Helen]

Quote:

Originally Posted by sengsational I'm curious...how did you pick 8 weeks? I've made diet and exercise choices, and wonder how long it will take to alter the lipid profile.

A cardiologist gave a talk where I work and said it takes about six weeks for a diet change to show in cholesterol levels in the blood. I'm adding an additional two weeks onto that.

[HawkeyeNFO]

Quote:

Originally Posted by Helen A cardiologist gave a talk where I work and said it takes about six weeks for a diet change to show in cholesterol levels in the blood. I'm adding an additional two weeks onto that.

In 2008, after about 12-14 weeks, I dropped my total chol number nearly 100 points. No drugs, just diet & exercise.

[Helen]

Quote:

Originally Posted by HawkeyeNFO In 2008, after about 12-14 weeks, I dropped my total chol number nearly 100 points. No drugs, just diet & exercise.

I'm having this blood test done through work and I am retiring in 4 weeks, so next week is probably the latest I should wait to have this done.

Did you go vegan also? I think we discussed this on another thread. A 100 point drop is really impressive. The cardiologists at the talk said a 10% drop in LDL was the typical effect from cleaning up a diet, unless the diet was really bad before (like a Supersize Me diet.) What was your diet like when your total chol numbers were 100 points higher?

[braumeister]

As Helen pointed out, this is a fairly complex area, and it may be best to consider a number of different measurements.

For me, HDL and Triglycerides are most important.

I want my Total Cholesterol/HDL ratio to be under 5 (it's now a bit over 3).

I want my Triglycerides/HDL ratio to be under 3 (it's now a bit over 1). Many scientists say that this ratio is a good stand-in for LDL particle size (lower ratio means fewer, larger particles).

I'm pretty sure haha had his particle size measured (on his own dime), so he will probably have a good comment soon.

[donheff]

Quote:

Originally Posted by sengsational Last time I went for my annual physical, I tried to get my doctor to run an advanced version of the lipid profile that exposed more detail about what the particle sizes were for my LDL concentration. He didn't want to do it because insurance wouldn't pay (that's a separate discussion), so I didn't argue and so I don't have that result. But I'm scheduling this year's visit, and am going to try again, since last time my LDL was considered to be less than optimal, and knowing the particle sizes would help to understand if action needs to be taken or not.

If you are really interested, just pay for the test. I did that with a standard lipid panel about two months into a LCHF diet since I wasn't due up for a covered test thru insurance at that time. Testing for particle size costs more but if you are really concerned a one time expense isn't the end of the world.

Quote:

Originally Posted by Helen After 8 weeks on a vegan diet, I am going in next week to have my cholesterol tested again.

Please post your results here and let us know what your diet and numbers were prior to the test and this time. It is just one data point but interesting nonetheless. I could never go vegetarian, let alone vegan, but I am curious if individuals who actually run blood tests see significant (in lay terms) results.

[Helen]

Quote:

Originally Posted by sengsational Yes, I did read something about how TG and HDL readings can be used as a predictor of LDL particle size. Using those values as a proxy, I'm in pretty good shape, which is why, even though my LDL-C not low, I've felt justified in my not taking statins. What I read, though, is that those other values as a proxy are not always on target. I think that works pretty well in a person with metabolic syndrome ("normal" LDL-C, but high TG and low HDL), but that's not me.

I don't understand why insurance companies will pay for statins but not for the more expensive cholesterol test to see what type of LDL a person has.

[Helen]

Quote:

Originally Posted by donheff Please post your results here and let us know what your diet and numbers were prior to the test and this time. It is just one data point but interesting nonetheless. I could never go vegetarian, let alone vegan, but I am curious if individuals who actually run blood tests see significant (in lay terms) results.

I will be happy to. My guess is that I won't see much of a change.

[Coach]

My doc does an extensive lipids test from Health Diagnostic Laboratory, Inc. If insurance won't pay (mine does not), the company does not charge the patient. I don't know if this is a deal my doc worked out, or if it is more generally true.

Coach

[Chuckanut]

Quote:

Originally Posted by Helen I don't understand why insurance companies will pay for statins but not for the more expensive cholesterol test to see what type of LDL a person has.

+1 Bingo!

[Lsbcal]

I don't get the need for making public polls. Why not an old fashion anonymous one?

[Tyro]

Quote:

Originally Posted by heeyy_joe I read recently that vitamin B-3 reduces cholesterol. Anybody up on that?

I am not a doctor, nor do I play one on TV.

B3 = Niacin. Tests have been contradictory, so the jury is not in, however the evidence I've seen against niacin has been overwhelmingly from sources with motives to discredit it (like mfrs/sellers of statins).

Everyone is different, so may respond differently to any particular therapy. IMO, niacin is less risky than statins, and for most people, there should be no harm in trying it. The proof will be in the numbers. There are other ways of changing cholesterol numbers as well (diet, exercise, etc.)

http://www.google.com/search?q=lower...8&sourceid=ie7

http://www.google.com/search?q=raisi...8&sourceid=ie7

DW was prescribed one of the scarier statins (I don't recall which one off the top of my head), so after researching it, requested if she could try niacin instead. Dr. prescribed Niaspan®. After filling it, we learned that the exact same thing can be gotten OTC for less than 1/10 the cost (so that's what she uses now -- slo-niacin). Her tests since have come back with numbers as low or lower than when on the statin. Her doctor was surprised, but is satisfied with the results.

Couple of mentions: Not all niacin is created equal (not all forms work for helping control cholesterol), so if you go that way, make sure it's a timed/continuous release formula of nicotinic acid -- not niacinamide (a.k.a. nicotinamide) which does not have the same effects on cholesterol. Secondly, niacin (nicotinic acid) can have some side effects, the most notorious being "niacin flush". Niacin flush can be attenuated or eliminated by taking 500mg of vitamin C or one aspirin half an hour before taking the niacin, and by taking the niacin at bedtime (flushing is less noticeable for some people when asleep). Nicotinic acid may become toxic at very high levels, so once someone finds out if it works for them, the next step is to reduce the daily dosage to the munimum required to achieve the desired results.

Niacin (nicotinic acid, vitamin B3, Niacor, Niaspan, Slo-Niacin) to Cholesterol Lowering Drug Information by MedicineNet.com

Mayoclinic.com also has some info on this, but they were experiencing some server problems.

Your doctor shouldn't have any problem with trying niacin as long as there are no contributing medical issues, but by all means keep him/her in the loop to help monitor.

Tyro

[ERhoosier]

Quote:

Originally Posted by HawkeyeNFO In 2008, after about 12-14 weeks, I dropped my total chol number nearly 100 points. No drugs, just diet & exercise.

Goes along with my experience. I have chol level checks going back 20+yrs. Lowest my #'s have ever been was late 2011 while training for my ironman triathlon. Was doing 15-18hrs/wk (time actually on the HR monitor) of aerobic exercise for several wks during peak phase. Also watching my diet, although not to OCD level Last yr I was mainly run training (a few short tri's, 2 HM's, & 2 full marathons), so total training time was down while my diet didn't change. My cholesterol #'s rose significantly, though still in lowest-risk range for both LDL & HDL/LDL ratio. LDL particle size remained low-risk. No change in medications at all during those 2+ yrs.

From what I've read, diet + exercise decrease chol levels (sometimes dramatically) in many but not all people. I know of no test that predicts whose #'s will drop vs those whose # won't, but good diet & exercise has many health benefits beyond chol #'s. What seems to help most is duration (not intensity) of exercise. In my case, my #'s were lower on more low-intensity exercise hrs/wk (2011) vs fewer but higher-intensity hrs/wk (2012).

[bo_knows]

Quote:

Originally Posted by Nikki J Do you know your triglyceride level? There is research showing those with higher ldl but tg below 70 have the better LDL particles and those over 140 tg have the bad kind so you can decide treatment for those people with confidence without the particle size test if you are in the 70-140 range you might argue for the test

This is pretty much in line with everything that I've read on the subject.

Also, if you tend to eat more Meat/Veg/Fruit/Nut based diets, and forgo a lot of starchy carbohydrates, you actually tend to drift more toward higher LDL numbers and lower Triglyceride numbers, while still maintaining the "good LDL" and a healthy heart.

FWIW, I'm 31 and my LDL has been high for the past couple of years, but I'm well below 70 triglycerides, and I had the VAP test (one of the particle density tests) which showed that I was 100% in the "good LDL" camp.

Enough said for me.

[haha]

Quote:

Originally Posted by Lsbcal I don't get the need for making public polls. Why not an old fashion anonymous one?

I agree, I did not notice this (bad me)and next time I will not participate in a public poll. I may well give the same information in a post, but then at least I am sure to realize what I am doing.

I did have the test twice, once I paid, then my new doctor did it on Medicare. My second test gave fewer particles, and fewer small particles too. My doctor who happens to be a cardiologist feels that it is the LDL particle # that does the damage. This POV is put forward by Tom Dayspring MD, a lipidologist who may consult or even work for the lab that is able to do these tests. The only change I made was in volume and design of exercise program. Since then I have begun to eat less beef and lamb, so I will likely have a new test later this summer.

Doc said I didn't need treatment.

Ha