High Cholesterol despite correct weight, diet, exercise...What to do?

[Koolau]

^^^^

Yeah, this is the first time I've heard of the ratio. I know both triglycerides and cholesterol are "bad" but I hadn't heard of the ratio.

I assume my doc knew about this ratio but never suggested my "ratio" was bad. Not even after I had to have stents in my heart.

But the doc DID put me on the strongest statin in the drug store afterward.

 

[street]

They are different ratios. Some use one, some use the other.

Thank You audreyh1.

 

[RetiredHappy]

Ack. I can't get the editing thing to let me put extra spaces in to spread the numbers out a little for readability. Sorry! I'll put them in this format, too:

Test 1: TC 232, HDL 75, LDL ---, Tri 441, gluc 115
Test 2: TC 189, HDL 80, LDL 75, Tri 171, gluc 123
Test 3: TC 227, HDL 81, LDL 125, Tri 104, gluc 111

(And I still don't get the glucose numbers, compared to my post-Jersey-Mike's-sweet-tea numbers, but I'm confident I don't have diabetes so I don't care.)

I would say at minimum, you are pre-diabetic. Ask your doctor to get an A1C test.

 

[Chuckanut]

I use trigs/HDL.

https://thebloodcode.com/tghdl-calculator/

The HDL, on it’s own, represents how well your liver is producing the useful and healthful HDL-cholesterol. But if you have high TG, your HDL usually drops. Conversely, as you move toward a healthier metabolism, your TG will reduce and your HDL will go up. The ratio between the two is important.
The Blood Code Reference Ranges
Optimal range: 0.5–1.9
Some insulin resistance: 2.0–3.0
Significant insulin resistance and heart disease risk is found at ratios >3.0

https://prevmedhealth.com/more-important-than-ldl-the-triglyceride-hdl-ratio/

Some information wasn’t that new. For example, Attia and Dayspring mentioned that the Framingham study indicates that TG/HDL (triglycerides over HDL ratio) is 5 times more predictive of heart attack risk than LDL.

 

[ShadowBloom]

My total cholesterol is typically over 200, but the breakdown I think is very atypical. Last year was HDL 92, tri 48, LDL 119. My doctor isn't concerned. I never was either, until I started reading this year that very high levels of HDL aren't protective. But then my triglycerides are seemingly very low, so I don't know if that counters that.

My fasting glucose is also usually high, around 105-110, occasionally in the upper 90s. But my a1c numbers have been 5.2-5.7. So I don't know if I should be concerned about this either.

Mostly I find the numbers interesting but not that helpful.

 

[audreyh1]

My total cholesterol is typically over 200, but the breakdown I think is very atypical. Last year was HDL 92, tri 48, LDL 119. My doctor isn't concerned. I never was either, until I started reading this year that very high levels of HDL aren't protective. But then my triglycerides are seemingly very low, so I don't know if that counters that.

My fasting glucose is also usually high, around 105-110, occasionally in the upper 90s. But my a1c numbers have been 5.2-5.7. So I don't know if I should be concerned about this either.

Mostly I find the numbers interesting but not that helpful.

I think high levels of HDL are generally protective, but using drugs to boost HDL levels doesn’t increase protection. I guess there was some buzz about very high levels but already forgot all the details.

A1C numbers below 5.7 are generally considered fine and since your range is below that I don’t think you should be concerned especially with your triglycerides so low.

 

[Chuckanut]

I think high levels of HDL are generally protective, but using drugs to boost HDL levels doesn’t increase protection. I guess there was some buzz about very high levels but already forgot all the details.

A lot of substances in our body, consumed or made by the body, are what many people call “dose dependent”. LDL is that. Without it we would die, too much and we risk CVD. HDL seems to be similar in that while normal amount is protective, raising it to much higher levels does not offer much additional benefit. Perhaps the law of diminishing returns is at play. I don’t know. Vitamins and minerals are the same. We need Vit D, but too much can cause problems. It’s a giant, complex balancing act that somehow our bodies usually manage very well if we eat and drink properly. There’s the rub, that word “properly”.

 

[Koolau]

A lot of substances in our body, consumed or made by the body, are what many people call “dose dependent”. LDL is that. Without it we would die, too much and we risk CVD. HDL seems to be similar in that while normal amount is protective, raising it to much higher levels does not offer much additional benefit. Perhaps the law of diminishing returns is at play. I don’t know. Vitamins and minerals are the same. We need Vit D, but too much can cause problems. It’s a giant, complex balancing act that somehow our bodies usually manage very well if we eat and drink properly. There’s the rub, that word “properly”.

Heh, heh, always remember and never forget: None of us gets out of here alive.

Do the best you can with your health and enjoy the life you have!

 

[audreyh1]

A lot of substances in our body, consumed or made by the body, are what many people call “dose dependent”. LDL is that. Without it we would die, too much and we risk CVD. HDL seems to be similar in that while normal amount is protective, raising it to much higher levels does not offer much additional benefit. Perhaps the law of diminishing returns is at play. I don’t know. Vitamins and minerals are the same. We need Vit D, but too much can cause problems. It’s a giant, complex balancing act that somehow our bodies usually manage very well if we eat and drink properly. There’s the rub, that word “properly”.

Yes we absolutely need LDL as it plays several key roles including immune system support. It’s actually the small dense LDL that can cause problems but the regular cholesterol tests don’t distinguish between small and large LDL.

 

[Safe Harbour]

I have a little different take than most people here. I believe there is no such thing as too low of an LDL. I suggest you spend $18 on Amazon and buy Dr. Peter Attia's book Outlive. His practice is in providing the absolute best state of the art healthspan care. They help you live your life as your most healthy active independent self possible. He along with two world renowned cardiologist I have worked with say that an LDL of 30 should be your goal. They all recommend everyone takes a statin. If your LDL isn't under 50 they suggest a PCSK9 inhibitor also be added. You can also go to https://peterattiamd.com and search his podcast notes for cholesterol.

Aging is all about preventing chronic diseases of the cardiovascular system, diabetes, dementia, and cancer. LDL plays a role in all of them and they all start decades before most physicians would be concerned for you.

 

[JBTX]

Check out the NNT (number needed to treat): https://thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease-2/

This was for no heart disease:

None were helped (life saved)
1 in 104 were helped (preventing heart attack)
1 in 154 were helped (preventing stroke)
Harms:
1 in 50 were harmed (develop diabetes)
1 in 10 were harmed (muscle damage)

Numbers are better if known heart disease.

1 in 83 were helped (life saved)
1 in 39 were helped (preventing non-fatal heart attack)
1 in 125 were helped (preventing stroke)

This is kind of a flawed framework. If you don’t have heart disease the chance a statin is going to save your life over five years is obviously very low. Over decades it is much higher. This is a condition that tends to build up over time.

- As to muscle damage, studies of shown that much of it is a “nocebo” effect. The actual difference from placebo groups is much lower in double blind studies.

- You can get a substantial reduction - at least 30% or more with just 5 mg of crestor, which is half of the lowest recommended dose of 10mg and studies have shown almost no side effects at that dose.

- ultimately a statin should be combined with lifestyle changes to minimize the chance of diabetes. To the extent that doesn’t work metformin can help, which is a safe medicine with other potential benefits.

Like I said before, for anyone with borderline numbers I’d highly recommend a coronary calcium scan. I wish I had done it a few years ago.

 

[Amethyst]

Where can one order their own coronary calcium scan, and the test to distinguish between small and big LDL particles?
I just visited Quest Diagnostic Lab's web site (it's where the doctors send me) and they don't list either of these tests as something I can purchase.

 

[Chuckanut]

T

- You can get a substantial reduction - at least 30% or more with just 5 mg of crestor, which is half of the lowest recommended dose of 10mg and studies have shown almost no side effects at that dose.

+1


The initial small dose of a statin gives the largest absolute reduction in cholesterol levels. After that, each doubling of the dose reduces cholesterol by 6%. Statins are a great example of the law of diminishing returns. As you go up the dosage scale you need larger and larger increases to get that 6% reduction.

 

[audreyh1]

Where can one order their own coronary calcium scan, and the test to distinguish between small and big LDL particles?
I just visited Quest Diagnostic Lab's web site (it's where the doctors send me) and they don't list either of these tests as something I can purchase.

The particle test I think is called NMR for small versus large LDL.

You can call the radiology department at hospitals in your area and ask about a Cardiac Calcium Score, price etc. You probably don’t need an order for it.

 

[reneeh63]

I use reqestatest.com, also suggested by someone on this site. No BS, no surprise bills. They tell you what the tests will cost, you pay it, you show up at the lab and typically results are on-line the next day.

Also ultalabtests.com - no blood draw fee and very comparable rates on lab tests with frequent sales to make them even cheaper.

 

[bgares]

All good suggestions, always try to alter you diet within reason. NIaspan will increase your HDL and marginally reduce your LDL, so long as you can tolerate it. It causes flushing and is usually prescribed to be taken just before bedtime. If you don’t consumer enough fiber, you can try Metamucil or dry nopal cactus capsules. With some many people working long hours indoors, many of us are vit D deficient. Another important vitamin for your body to properly process calcium is vitamin K. Most of the commercial foods we buy and eat are woefully deficient in all the essential vitamin. For cardio vascular health in take 1500mg Krill oil, 1000mg omega 7 and 50 mcg vit. D3 with 80 mcg vit. K2 daily
Most strangers guess my age 50-55, I’ll be 68 my next birthday. Everyone have a good night!

 

[FIREd_2015]

Where can one order their own coronary calcium scan, and the test to distinguish between small and big LDL particles?
I just visited Quest Diagnostic Lab's web site (it's where the doctors send me) and they don't list either of these tests as something I can purchase.

Since Jasonhealth.com uses Quest Diagnostics I'm assuming the test description and codes are the same. On JasonHealth.com it's called Advanced Lipid Panel, Cardio IQ - Quest test code 92145. Price on Jasonhealth.com is $130 + $18 lab collection fee.

 

[JBTX]

+1


The initial small dose of a statin gives the largest absolute reduction in cholesterol levels. After that, each doubling of the dose reduces cholesterol by 6%. Statins are a great example of the law of diminishing returns. As you go up the dosage scale you need larger and larger increases to get that 6% reduction.

My doctor prescribed 10mg crestor, but I split the pills to 5mg. After 6 months I went from LDL 120 to LDL of 70. I also lost 20 more lbs so that probably made a difference too.

I’ve since bumped back to 10mg because I dropped the plant sterol supplements, and I’d like to get LDL in the 50’s. Have lost another 5 lbs and hope to lose another 5. I also started taking metformin - not prescribed by my doctor but I had a bunch of extra from family member. Mainly to keep blood sugar and A1C levels in check - they were borderline, but also to help reduce appetite a bit. Will be interesting to see what doctor says about me taking the med without a script - but everything I read it is a very safe med.

I will try that Jason’s test site.

 

[JBTX]

I have a little different take than most people here. I believe there is no such thing as too low of an LDL. I suggest you spend $18 on Amazon and buy Dr. Peter Attia's book Outlive. His practice is in providing the absolute best state of the art healthspan care. They help you live your life as your most healthy active independent self possible. He along with two world renowned cardiologist I have worked with say that an LDL of 30 should be your goal. They all recommend everyone takes a statin. If your LDL isn't under 50 they suggest a PCSK9 inhibitor also be added. You can also go to https://peterattiamd.com and search his podcast notes for cholesterol.

Aging is all about preventing chronic diseases of the cardiovascular system, diabetes, dementia, and cancer. LDL plays a role in all of them and they all start decades before most physicians would be concerned for you.

I signed up for the drive podcast and have found very interesting. I like some of the deep dives into the subjects. He seems very evidence based and willing to go wherever that takes you. I do recall they are very supportive of using statins for driving LDL very low if needed, but I don’t recall them saying everyone should take statins. I may be wrong.

I heard a recent episode they talked about a new cholesterol drug in testing, a CTEP inhibitor which is supposed to be as good as stains, no known side effects, tends to also drive HDL higher and marginally decreases blood sugar vs increasing like statins. It has been through numerous phase 2 trials. It can also be stacked on top of a statin.

https://www.nature.com/articles/s41591-022-01936-7

 

[shafer9]

Cholesterol

FWIW, 25 years ago, my doc put me on 5mg daily of Lipitor, my overall number was 235. It brought it all down. I hate taking meds so I played with dosages. For the last 10 years I take 15mg A WEEK. Keeps numbers reasonable. My mom had high cholesterol, it’s hereditary. I’m 78. I eat sensibly and work out 6 days a week. So far so good.

 

[FIREd_2015]

Also ultalabtests.com - no blood draw fee and very comparable rates on lab tests with frequent sales to make them even cheaper.

I was comparing ultalabtests.com to Jasonhealth.com. It looks like ultalabtests.com has better prices than Jasonhealth.com at least for the cardiovascular tests I'm interested in and it looks like they both use Quest Diagnostics. I'll have to give ultalabtests.com a try. Thanks for the tip.

 

[Buckeye]

Have you done a CT Calcium Score Scan to take a peek "inside?" It will be another data point. The tests usually cost about $100 and are not covered by insurance (which is probably why they are so cheap). My numbers (except the zero extra weight), age, and diet look a lot like yours. My calcium score was zero. It's not everything but I'll take zero!

 

[Buckeye]

The particle test I think is called NMR for small versus large LDL.

You can call the radiology department at hospitals in your area and ask about a Cardiac Calcium Score, price etc. You probably don’t need an order for it.

It might vary by location but in Central FL, an order is required to get the Cardiac Calcium Score scan done.

 

[NoEZmoney]

Look into Niacin supplements

Been taking niacin supplements for years and my total cholesterol runs from 190 to 220 range. But doc tells me my good to bad cholesterol ratio is excellent. I read years ago how B3 / Niacin daily can help this. You need the nicotinic acid kind that makes you flush and tingle as the flush-free won'tcut it.. I take about 200 mg daily between meals. Ask your doc before adding to your regime. This has helped me avoid statins which have certain undesirable issues.
Good luck.

 

[JBTX]

Been taking niacin supplements for years and my total cholesterol runs from 190 to 220 range. But doc tells me my good to bad cholesterol ratio is excellent. I read years ago how B3 / Niacin daily can help this. You need the nicotinic acid kind that makes you flush and tingle as the flush-free won'tcut it.. I take about 200 mg daily between meals. Ask your doc before adding to your regime. This has helped me avoid statins which have certain undesirable issues.
Good luck.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829575/

The relationship between HDL and cardiovascular disease is complicated. Whether your are lowering your risk taking Niacin isn’t clear.