'Good' cholesterol doctrine may be flawed: study

[tjscott0]

'Good' cholesterol doctrine may be flawed: study - Yahoo! News

Researchers on Thursday challenged a tenet of modern medicine that higher levels of "good" cholesterol automatically boost cardiovascular health.
In a study published in The Lancet, investigators said they found no evidence to back the belief that higher levels of high-density lipoprotein (HDL) cholesterol routinely reduce the risk of a heart attack.

 

[Katsmeow]

I just read the NY Times article on this:

http://www.nytimes.com/2012/05/17/h...-cut-heart-risk.html?_r=1&emc=tnt&tntemail1=y

The idea expressed is that while there is an association between HDL and people having lower risk of heart disease it is possible that it isn't the increased HDL causing the lower risk. That is, it could be something else that causes both the lower risk and the higher HDL and if you just have the higher HDL (such as through a genetic propensity for higher HDL) then that alone may not reduce heart disease risk. Very interesting article and findings.

 

[bo_knows]

Most of the studies that I have read in the past few years indicate more of an importance between the "Triglyceride / HDL ratio".

"An abnormal ratio of triglycerides to HDL-cholesterol (TG/HDL-c) indicates an atherogenic lipid profile and a risk for the development of coronary disease."

High Ratio of Triglycerides to HDL-Cholesterol Predicts Extensive Coronary Disease

There is other research that backs this up saying that there are 2 different types of LDL. A "large fluffy LDL particle" that helps move triglycerides through the system, and a "small dense LDL particle" that tends to get stuck in the lining of the vascular system. The generic blood tests that doctors do measure HDL and triglycerides, and estimate the LDL(all types).

What this means is, you can have a "high" total cholesterol (typically >200) and still be in a very low risk for heart disease, if you have the following profile: High HDL, very low Triglycerides, High LDL.

The only real way to figure this out is to get a Lipoprotein Density Panel (VAP is a popular one) if you're curious. But, most of these studies show that if your HDL is >40 and your Triglycerides are <70, then you almost certainly have all "large fluffy LDL" regardless of how high it is.

 

[haha]

From the NYT article:
“I often see patients in the clinic with low HDL levels who ask how they can raise it,” Dr. Kathiresan said. “I tell them, ‘It means you are at increased risk, but I don’t know if raising it will affect your risk.’ ”
That often does not go over well, he added. The notion that HDL is protective is so entrenched that the study’s conclusions may prove hard to accept, he and other researchers said.
“When people see numbers in the abnormal range they want to do something about it,” Dr. Kathiresan said. “It is very hard to get across the concept that the safest thing might be to leave people alone.”

I hope he has discovered a way to get that across to other doctors, and to health journalists and the public health pronouncements cabal.

Ha

 

[MichaelB]

From the NYT article:
“I often see patients in the clinic with low HDL levels who ask how they can raise it,” Dr. Kathiresan said. “I tell them, ‘It means you are at increased risk, but I don’t know if raising it will affect your risk.’ ”
That often does not go over well, he added. The notion that HDL is protective is so entrenched that the study’s conclusions may prove hard to accept, he and other researchers said.
“When people see numbers in the abnormal range they want to do something about it,” Dr. Kathiresan said. “It is very hard to get across the concept that the safest thing might be to leave people alone.”

I hope he has discovered a way to get that across to other doctors, and to health journalists and the public health pronouncements cabal.

Ha

Ha, that's a really good point, but not doing anything is so contrary to our way of life in the US I don't see how it can come about.

 

[Midpack]

From the NYT article:
“I often see patients in the clinic with low HDL levels who ask how they can raise it,” Dr. Kathiresan said. “I tell them, ‘It means you are at increased risk, but I don’t know if raising it will affect your risk.’ ”
That often does not go over well, he added. The notion that HDL is protective is so entrenched that the study’s conclusions may prove hard to accept, he and other researchers said.
“When people see numbers in the abnormal range they want to do something about it,” Dr. Kathiresan said. “It is very hard to get across the concept that the safest thing might be to leave people alone.”

I hope he has discovered a way to get that across to other doctors, and to health journalists and the public health pronouncements cabal.

Ha

I hope that's true. I have very low cholesterol including low HDL (real and ratio). Doctors told me to take niacin which I did daily for years and it increased my HDL from 28 to 32 IIRC. I was underwhelmed with the "improvement" and somewhat arbitrarily stopped a while back because I also want to believe being 'left alone' when I'm in very good health seems sensible. If I'm wrong, so be it...

 

[haha]

People survived for all but the last 30-40 hears without having a clue what their cholesterol was, or why they should care.

I think mainly these concerns are good for the doctor business, but of little import one way or another to the patients. And the cholesterol fixation definitely has decreased many a well person's mental and emotional comfort.

There is a professor of medicine at UCNC medical school who will not let his cholesterol be checked. Nortin Hadler is his name, and he written several books about the overall worthlessness of much that occupies the medical agenda today, and the cost in terms of emotional well being and money.

Ha

 

[Katsmeow]

I am not sure this study proves that cholesterol numbers or HDL or LDL, etc. don't mean anything. I think what it does show is that our understanding of what these things means is really very, very incomplete. Perhaps so incomplete as to not mean much at all.

My understanding is that research does show that people with high HDL do in fact have less risk of heart disease (as a group) than people with low HDL (as a group). The assumption had been that HDL itself was protective and actually caused the lower risk of heart disease.

What this study calls into question is causation. That is, simply having more HDL by itself does not seem to lower heart disease risk. This because people who genetically have higher HDL levels apparently don't have lower heart disease risk.

But...that doesn't necessarily mean that raising HDL for most of us is meaningless. That is, it may well be for most people that doing the things that raise HDL are things which also lower heart disease risk. If so, then it is doing those things that lowers the heart disease risk rather than increasing HDL. A high level of HDL for most people would then simply be a marker that that person was probably doing things that tends to lower heart disease risk. But it wouldn't tell you much about the person who has a high level of HDL even without doing those things that typically increase HDL or about the person who has a low level of HDL even with doing those things that typically increase HDL.

 

[haha]

Good analysis. Actually I did not mean that these numbers mean nothing, only that whatever meaning there may be is so obscure as to make it not worth bothering about, with our current level of knowledge. Whatever people may try to do seems just as likely to hurt them as help them. Example is the current backpedaling on low fat/high carb diets. Exercise seems fairly safe, as people have been doing it since people began, and our primate and other ancestors been doing it even longer. Yet 50-60 yers ago, doctors often advised against exercise. "Too dangerous for the heart!"

There is a good body of research about exercise and these various lipoproteins. In general, the same stuff improves all these markers. The old standby, VO2 Max is less correlated to anything than wold have been expected, since lately many people are recommending short high internsity intervals which are great sport training, but don't do a whole lot for particle size and number, triglycerides, etc.

A doctor might have a hard time saying, "hey, we have misled the public so often and so egregiously, just do what you want and ignore this as we don't understand it either". Because then when you have your MI, guess who gets to be a defendent in a malpractice suit.

Ha