New cardiologist not care about my cholesterol

[badatmath]

This was not a big shock exactly as it has been high (220-240) for a good 30 years and none of the several PCP or other cardiologist has cared either. . . . PCP says always runs higher in her thyroid patients . . . it just struck me as so odd the way he said it. Basically that they had been in there poking around taking photos (I had an angiogram in the hospital a bit back due to hypertensive crisis) and he was like more or less we can see you don't have any build up nothing to treat.

I'm good with this as I didn't want meds and was there for blood pressure . . . but I thought some of you would probably be amazed since I know many here have very very conservative goals for it. Of course if I develop more problems or get older they may change their tune. I just thought I'd throw it out there since I was thinking over the visit.

No real point to this post I guess. . . not trying to convince anyone to ignore what their doctor advises based on their circumstances of course.

He was at least open to trying to reduce my bp meds so that was a plus. Some of them think if 120 is good then 100 is better. . . . um not if it requires multiple meds . . . at least not as far as I am concerned.

I should have asked him about the local research study trying to get people to get their LP(a) checked but I didn't. I don't really want to know mine as there is nothing I can do about it. Figured mine would suck and I'd just worry. Not worth at $45 gift card.

 

[ER Eddie]

Good. It's nice to see some physicians who are clued in. The medical-pharmaceutical-food industrial complex has been under this spell for way too long.

Good news that you don't have any appreciable plaque. That's the main way I got my doctor to back off on the "high cholesterol, you must need statins!" rigamarole.

 

[MarieIG]

As a non- medical person - it is my understanding that the disease is not "cholesterol" it is arteriolosclerosis. Since you've been in the same range for 30 years - and you had an angiogram which confirmed "you don't have any build up" it does not seem unreasonable to me that in your case he is ok with your numbers. I would expect different patients to have different needs. But again, I am not a medical expert so take this with a grain of salt.

(When I next get my bloodwork I would like my medical care provider to obtain a more comprehensive / detailed cholesterol panel and will of course want to see triglycerides.)

 

[athena53]

My total cholesterol runs high but only my LDL is outside of "acceptable" limits. Calcium score is 1. I have periodic echocardiograms due to mitral valve prolapse. A couple of lipoproteins (apo-A and apo-B) and the ratio between them are more important; my apo-B is very high but the A/B ratio is OK and my cardiologist is not excited. I have zero other risk factors: I'm a healthy weight, daily cardio workouts, practically vegetarian, normal BP.

Total cholesterol is DEFINITELY very simplistic. I'm glad your doc looks at the overall picture.

 

[FIREd_2015]

This was not a big shock exactly as it has been high (220-240) for a good 30 years and none of the several PCP or other cardiologist has cared either. . . . I should have asked him about the local research study trying to get people to get their LP(a) checked... .

My cholesterol has been in the 200-240 range most of my adult life. The last two years I paid out of pocket and ordered the APO B and A1 test using JasonHealth.com. It turns out my APO B/A1 ratio of 0.63 is in the optimal range (<0.77). I've read articles that suggest APO B/A1 may be a better indicator of cardiovascular risk than LP(a). I've never been on statins.

 

[Teacher Terry]

It’s encouraging to see that some doctors are more up to date on cholesterol and not just blindly recommending statins. BP naturally gets higher with age and most doctors realize this. I have been on HBP medication for 20 years as it’s genetic in my family. No one seems to escape it. I’ve never had a doctor try to get it lower than 130 even when much younger.

 

[Chuckanut]

My HDL/Trig ratio is very good. I am told this is a far better predictor of cardiovascular disease than cholesterol levels.

It is confusing to say the least.

 

[Golden Mean]

My HDL/Trig ratio is very good. I am told this is a far better predictor of cardiovascular disease than cholesterol levels.

It is confusing to say the least.

It can be frustrating to understand why cholesterol was vilified. But now, that idea is stuck in the minds of the public and most doctors and will probably never let it go.

Nina Teicholz's book The Big Fat Surprise (with full bibliography) can help fill in the back story. Long story short; it partially involves people trying to further their careers in the 1950's using bad/no science, as well as a powerful religious sect that spends lots of money pushing vegetarianism.

 

[teej1985]

This was not a big shock exactly as it has been high (220-240) for a good 30 years and none of the several PCP or other cardiologist has cared either. . . . PCP says always runs higher in her thyroid patients . . . it just struck me as so odd the way he said it. Basically that they had been in there poking around taking photos (I had an angiogram in the hospital a bit back due to hypertensive crisis) and he was like more or less we can see you don't have any build up nothing to treat.

I'm good with this as I didn't want meds and was there for blood pressure . . . but I thought some of you would probably be amazed since I know many here have very very conservative goals for it. Of course if I develop more problems or get older they may change their tune. I just thought I'd throw it out there since I was thinking over the visit.

No real point to this post I guess. . . not trying to convince anyone to ignore what their doctor advises based on their circumstances of course.

He was at least open to trying to reduce my bp meds so that was a plus. Some of them think if 120 is good then 100 is better. . . . um not if it requires multiple meds . . . at least not as far as I am concerned.

I should have asked him about the local research study trying to get people to get their LP(a) checked but I didn't. I don't really want to know mine as there is nothing I can do about it. Figured mine would suck and I'd just worry. Not worth at $45 gift card.

What thyroid issue do you have?

 

[athena53]

My cholesterol has been in the 200-240 range most of my adult life. The last two years I paid out of pocket and ordered the APO B and A1 test using JasonHealth.com. It turns out my APO B/A1 ratio of 0.63 is in the optimal range (<0.77). I've read articles that suggest APO B/A1 may be a better indicator of cardiovascular risk than LP(a). I've never been on statins.

I use RequestaTest.com. It's VERY good to have ways (in most states- I know AZ is an exception) to order what you want and know the cost up front.

 

[badatmath]

What thyroid issue do you have?

Hypo. More than one PCP has told me over the years that some people do not respond adequately to the meds (our numbers look okay mostly on blood tests) but we still show symptoms and our livers? simply do not process cholesterol the same as "normal" folks. They aren't sure why. IDK if I believe this just but definitely more than one has told me the same thing. My HDL and Tri are good too so I do not worry over it.

It was something about the way he referred to me as not being damaged so far by it that kind of surprised me more than anything. Kind of like being told the sink isn't clogged when you had not thought so. And the test was some months back so it wasn't like I had not known the result was okay.

It’s encouraging to see that some doctors are more up to date on cholesterol and not just blindly recommending statins. BP naturally gets higher with age and most doctors realize this. I have been on HBP medication for 20 years as it’s genetic in my family. No one seems to escape it. I’ve never had a doctor try to get it lower than 130 even when much younger.

Cardio wants me below 120 as did the last one. PCP is okay if under 140.

I think the additional walking I have done since retiring is pushing it down a bit and so meds might get to adjust down. No need IMO to see 100 as a systolic too often. I start feeling kind of crappy somewhere in there. But mine is largely genetic like the rest of the family. I'll never be med free but reduced works for me if that is the best I can do.

It would be great to know my AP levels if they were good but would only worry me if not so for now I am opting to keep my head in the sand.

 

[braumeister]

I use RequestaTest.com.

I use them as well. Also walkinlab.com (whichever is more convenient, as the prices are similar).

They both use LabCorp and Quest for the actual blood draw, both of which have many locations all over.

I'm a great believer in getting the tests I'm interested in, whenever I want them. Waiting until the annual doctor's session isn't always the best practice.

 

[teej1985]

Hypo. More than one PCP has told me over the years that some people do not respond adequately to the meds (our numbers look okay mostly on blood tests) but we still show symptoms and our livers? simply do not process cholesterol the same as "normal" folks. They aren't sure why. IDK if I believe this just but definitely more than one has told me the same thing. My HDL and Tri are good too so I do not worry over it.

It was something about the way he referred to me as not being damaged so far by it that kind of surprised me more than anything. Kind of like being told the sink isn't clogged when you had not thought so. And the test was some months back so it wasn't like I had not known the result was okay.

I got the hashimotos/hypo diagnosis myself not too long ago. I take 25mcg of Levo every day which seemed to improve the TSH good enough for the PCP. I'm in my late 30s. My cholesterol has been high too, but I figured that was diet related....I guess it might not be.

 

[badatmath]

I got the hashimotos/hypo diagnosis myself not too long ago. I take 25mcg of Levo every day which seemed to improve the TSH good enough for the PCP. I'm in my late 30s. My cholesterol has been high too, but I figured that was diet related....I guess it might not be.

I was diag as a child so I don't know much different and I am on a higher dose than you @ 112. But in the past 30 years I've certainly had better/worse exercise habits, diets, weight, etc and it has been pretty consistent. I have not ever done any research on the topic.

 

[Route246]

My BP has always been high and I've been on medication for 20+ years (lisinopril if that matters) and my BP in the morning is around 115/72 since I've taking medication. This is probably a good thing.

My cholesterol was always below threshold and recently went over and my doctor asked me if I would be interested in trying a statin. It was my choice as he said I'm not chronic but I am "qualified" to take it. I started on Atorvastatin/Lipitor and the results were positive and my numbers are now well inside the "good" range.

More recently my glucose numbers have been edging higher and likewise A1C is in the "prediabetes" range. He asked me if I wanted to try medication and prescribed Metformin and we shall see how that works.

Question: Now that I am firmly ensconced in the big pharma ecosystem is there much downside to ingesting meds and reaping the benefits of these bloodwork and blood pressure metrics being vastly improved vs not taking the meds and living with metrics that tend to indicate higher risk factors?

I've always felt that this is a game of statistics and the meds just tend to tilt the statistics to more favorable outcomes. Let's just say side effects in terms of comfort and quality of life are nil so the only risk is some long term damage to my body, I would guess.

 

[tulak]

I use them as well. Also walkinlab.com (whichever is more convenient, as the prices are similar).

They both use LabCorp and Quest for the actual blood draw, both of which have many locations all over.

I'm a great believer in getting the tests I'm interested in, whenever I want them. Waiting until the annual doctor's session isn't always the best practice.

I'm curious, do you share the test results with your doctor? Or do they automatically see the results if you use the same lab?

I'm contemplating getting more proactive in lab tests, but I suspect that my PCP will, at best, think it's useless, and at worst, not be happy since I'm not involving him in my care (and possibly doing things he wouldn't recommend).

Overall, I'm happy with my PCP, so I'd rather avoid any problems.

 

[teej1985]

My BP has always been high and I've been on medication for 20+ years (lisinopril if that matters) and my BP in the morning is around 115/72 since I've taking medication. This is probably a good thing.

My cholesterol was always below threshold and recently went over and my doctor asked me if I would be interested in trying a statin. It was my choice as he said I'm not chronic but I am "qualified" to take it. I started on Atorvastatin/Lipitor and the results were positive and my numbers are now well inside the "good" range.

More recently my glucose numbers have been edging higher and likewise A1C is in the "prediabetes" range. He asked me if I wanted to try medication and prescribed Metformin and we shall see how that works.

Question: Now that I am firmly ensconced in the big pharma ecosystem is there much downside to ingesting meds and reaping the benefits of these bloodwork and blood pressure metrics being vastly improved vs not taking the meds and living with metrics that tend to indicate higher risk factors?

I've always felt that this is a game of statistics and the meds just tend to tilt the statistics to more favorable outcomes. Let's just say side effects in terms of comfort and quality of life are nil so the only risk is some long term damage to my body, I would guess.

I'm curious what you perceive as long term body risks of taking the meds vs not taking the meds?

 

[badatmath]

I'm curious what you perceive as long term body risks of taking the meds vs not taking the meds?

I'm not who you directed the question to but over decades some medications can be bad for your kidneys, as an example. And if you already have kidney damage some medications need dosage adjustments.

Ideally the benefit from taking the medication outweighs the harm . . . but the doctors don't always know how it will turn out for an individual.

I *should* not be allergic to ACE per profile as I am not the race or gender in which it is most common . . . but I am. Bodies do weird things.

 

[GaryInCO]

My cholesterol levels were always high, up to the high 200's. For years my long-term MD said no worries, my ratios were good. But then when I got into my late 50's she said "OK we need to start dealing with this, let's start you on statins." I said "If you insist on statins, I get a new doctor." Then I sent her 3-4 studies and meta-analyses that showed statins didn't improve all-cause mortality at ALL. So she backed off.

(Studies also showed that the "get it below 200" mantra is flat wrong. For men the optimum all-cause survival is at about 250, and for women it's much higher. So they shouldn't even TRY to lower your chol unless you're around 300 or more.)

The next year she said "I know you don't want statins. Well I've found a natural supplement that lowers cholesterol. I want you to take it." I looked at the label and said "This is Red Yeast Rice. That's where statins COME from. Ain't takin' it."

The next year she said "OK, I'm really worried about your atherosclerosis. I'm bringing in a guy to do sonograms of your carotids. I want to find out how badly you're blocked." Great, I said, let's do it.

The results came back and said I had the arteries of a man half my age. ZERO occlusion. She never nagged me about cholesterol again.

 

[braumeister]

I'm curious, do you share the test results with your doctor? Or do they automatically see the results if you use the same lab?

I'm contemplating getting more proactive in lab tests, but I suspect that my PCP will, at best, think it's useless, and at worst, not be happy since I'm not involving him in my care (and possibly doing things he wouldn't recommend).

Overall, I'm happy with my PCP, so I'd rather avoid any problems.

Yes, she is happy to note them in my record and congratulates me for staying on top of my health.

 

[athena53]

I'm curious, do you share the test results with your doctor? Or do they automatically see the results if you use the same lab?

I'm contemplating getting more proactive in lab tests, but I suspect that my PCP will, at best, think it's useless, and at worst, not be happy since I'm not involving him in my care (and possibly doing things he wouldn't recommend).

Overall, I'm happy with my PCP, so I'd rather avoid any problems.

I share mine- never had a problem. I send them beforehand and most of the time they end up in my electronic records. I'd be concerned about a doc who had a problem with this. You're not seeing another doc, you're not taking prescriptions he/she doesn't know about and you're not getting invasive tests that carry risks of their own and are justified only by potential benefits (e.g., annual colonoscopies, cardiac catheterizations). You're just checking things more often than insurance will pay for and possibly different tests than insurance will cover.

I'm reading "Outlive" by Peter Attia and he talks about Medicine 3.0. Medicine 2.0 is still focused on treating what ails you. Medicine 3.0 is starting very early to monitor things that blow up when you're in your 60s or 70s and wreck the quality of your life in your last decade (whenever that is). In my case, a blood test in an Employee Wellness program showed high fasting glucose when I was 59. I changed my diet up a bit and started watching a1c. It started at 6.0 and is now around 5.4 12 years later. Still not great and I continue to test every 4-5 months. Somewhere in my medical records someone entered the diagnosis "pre-diabetic" back when it was higher.

No one told me. I suppose it was because I wasn't at the level that needed treatment, but where would I be now if I hadn't taken charge of my own testing?

 

[Golden Mean]

My cholesterol levels were always high, up to the high 200's. For years my long-term MD said no worries, my ratios were good. But then when I got into my late 50's she said "OK we need to start dealing with this, let's start you on statins." I said "If you insist on statins, I get a new doctor." Then I sent her 3-4 studies and meta-analyses that showed statins didn't improve all-cause mortality at ALL. So she backed off.

(Studies also showed that the "get it below 200" mantra is flat wrong. For men the optimum all-cause survival is at about 250, and for women it's much higher. So they shouldn't even TRY to lower your chol unless you're around 300 or more.)

I totally agree with your first part, but IMHO, trying to lower it all makes no sense. The numbers/thresholds thrown around are completely arbitrary and don't correlate at all to all-cause. There are lean mass hyper reponders with totals at or near 1000 with zero plaque. I compare it to someone saying being over 6ft tall is bad and everyone then trying drugs to make them shorter.

Your body produces these substances for a reason.

 

[braumeister]

It has been shown many times, not just in medicine but in all the sciences, that outmoded ideas are perpetuated as the conventional wisdom until all the senior authorities in the field are dead.

I think the classic example of something that hung on long past any reasonable time is the old "ulcers are caused by stress, not bacteria". Personally, I believe that we have somewhat the same thing going on today with "high cholesterol causes heart attacks".

But as the great biologist Lewis Thomas pointed out in one of his books, "One reason why medical history is not much taught in medical schools is that so much of it is an embarrassment."

 

[bjorn2bwild]

Just to throw a wrench in the works,
I know some here follow Peter Attia.
His position is decidedly aggressive on lowering blood lipids.
I'm posting just the crib notes, there is a lot more detail in his writings and podcasts.
He does caveat that the patient can tolerate the lipid lowering protocol, which he claims most do.
My wife's cardiologist agrees with most of this, although she is not nearly as strict and makes note of lifestyle adjustments.

When you look at a lot of the Mendelian randomizations plus the clinical trial data, if you have an LDL cholesterol below 30 or an ApoB below 40 milligrams per deciliter for a very long period of time, I think the odds that you’re going to suffer for ASCVD are incredibly low
The earlier you start and the lower you go the more you can make that number approximate zero

https://peterattiamd.com/early-and-aggressive-lowering-of-apob/

 

[braumeister]

Just to throw a wrench in the works,[/URL]

Not a wrench at all. There is an extremely wide range of opinions on these topics, and I think they have all been aired many times both here and elsewhere. We can all look at any evidence and interpret it however we like. It's good to have some confidence in your interpretation; the only caveat is to recognize that there are probably other interpretations and so far no really definitive answers that we can all agree on.