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Old 12-10-2020, 04:20 AM   #201
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ImThinkin - The heart score is a hit or miss. I supervised a large scale clinical trial using EBCT in younger men (under age 65) and it proved worthless. It is good for older men (above age 70) and has value. It is useful as it establishes calcium deposits in plaque which are what causes platelets to aggregate and start the inflammatory/coagulation cascade resulting in an ischemic event. Earlier attempts were made to measure plaque in carotid arteries and again proved worthless. I myself fell victim to this problem while in the military back in 1999. They determined I had major plaque deposits and started me on 100 mg/day lipitor (10 times the normal dose). The result was I had cataracts in 3 months due to the high dose lipitor. Later, the use of ultrasound for plaque measurement was debunked and found to not only be worthless but led to inappropriate treatments (like myself). I haven't had a statin since and had the cataracts removed in both eyes.

I wouldn't worry about any lipid levels at all. I believe (and many others as well) that our lipid levels go up as we age and it is perfectly normal. HDL was not found to actually be protective following a study where they engineered a particular type of HDL found in a genetically related group of people in Italy with zero heart disease but high lipid levels. It was hypothesized that they had n altered HDL molecule which protected them. Injecting this into others (in animal models) actually did nothing at all. The basic problem is we must have cholesterol and it must be readily available. All out hormones are made from it. Altering the lipid metabolism in the liver (which is what statins do) alters a lot of different things. Some are bad such as significantly higher risk of gallstones. In my case lipid deposits in the eyes causing cataracts. Personally, I don't believe in medication as a solution when diet and exercise perform better. Overall deaths due to ischemic events hasn't significantly altered despite massive use of statins which ought to be a major clue. It has gone down a bit but usually people going onto statins also modify their diets, at least for a short time so separating out the cause/effect is difficult without doing a long term (not 3 months) double blinded major study.
Hi Old Microbiologist, thank you so much for this. Interesting to hear what the findings were.

In my doctor's mind - faith maybe or what was learned in school - "HDL is protective and LDL is bad". Not sure if it's possible to get him to think otherwise. I think he's about 45 years old. And I worry that no matter what info I point him to, he may discount anything coming from me because I'm not a doctor. Just an overweight civilian........

Any suggestions for things I can tell him (that he will take seriously) if and when he tells me I need to get on statins?
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Old 12-10-2020, 04:30 AM   #202
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Thank you so much for writing the post the way you did. It is helpful.

I am anticipating a slightly energetic discussion with my somewhat young new doctor in 5 months. Last vist he told me to lose weight so I went on a keto diet which is helping. But my LDL went from accepted range to out of range. (151 - typically it runs closer to 100 calculated.). He wants to put me on statins and I don't really want that.

We will see what the LDL is before my next appointment. Maybe I can get him to measure small and large LDL. My cardiac score - just done - was perfect. No detectable deposits. 63 years old.
I think conventionally trained doctors don’t know what to do with a patient who has higher LDL yet a calcium score of 0. Even Peter Attia and colleagues back off.

Maybe before too long you won’t be an overweight civilian.

My personal experience is that higher fat diet (and maybe it’s more the saturated fat) = higher HDL and LDL which also raises total cholesterol. I think this increase is fairly common. Studies that I’ve read about don’t find a link between higher fat intake and increase risk for heart disease - at worst it’s neutral.

I have an Trig/HDL ratio of 1. Last time they were both 67. That’s a pretty low Triglyceride level too which has been my goal. Studies indicate that such a low ratio means very low heart disease risk, and that the increased LDL running around in my veins is the large fluffy kind that is not risky for forming plaque. That is supposed to be typical for higher fat diets - the increase in LDL is the large particle type.

But my PCP is starting to look askance at my numbers and wants my total cholesterol to come down even though my other numbers (A1C of 4.9, for example) are excellent, and I am normal weight.
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Old 12-10-2020, 05:21 AM   #203
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But my PCP is starting to look askance at my numbers and wants my total cholesterol to come down even though my other numbers (A1C of 4.9, for example) are excellent, and I am normal weight.
Same here. My cholesterol has been very high all my life, but my HDL, trigs, and all ratios are excellent. I agree with Old Micro that cholesterol numbers have probably nothing to do with heart disease, but we're definitely in the minority and I've mostly learned to keep quiet about that.

My current doc finally started listening to me and ended up saying he would stop bugging me about it if I got a stress echo test, along with an AAA and carotid ultrasound scans. They all came out perfect so he decided to just scratch his head about it and leave me alone.
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Old 12-10-2020, 06:41 AM   #204
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Braumeister - Being a well published research scientist helps a bit. We are lucky that in our smallish town is the National Cardiological Institute so we have a plethora of cardiologists in our small town. It is something like 60 cardiologists for a population of roughly 20,000. I am friends with the Institute director and he is 75 years old. The Director of the Emergency Medicine and Intensive Care unit is my wife's cardiologist (I don't need one myself although I get an annual checkup with them) and is younger at 45. The Director interestingly confides in me that statins only help the pharmaceutical industry but he is old school. The younger doctor who is also a PhD research scientist and well published on the role of platelets in ischemia believes absolutely in statins. I always accompany my wife (as I speak the lingo and am respected more or less) and I always enjoy an honest debate with this cardiologist. I finally got him to agree that widespread statin use hasn't affected mortality. He is closer to the root of the problem which is platelet adhesion and it is true that calcification of plaque deposits is a leading cause for the release of plaque and immediate coagulation and subsequent blockages in narrow arteries somewhere else (could be anywhere). He is a big believer in anticoagulants if there is risk (me too). My wife has right atrial fibrillation which is associated with pooling of blood in the atrium which can result in large clot formation. Other than the role cholesterol has in forming plaque there isn't too much else it can be blamed for. The real question is why plaque forms in the first place and there is a plethora of evidence it is caused by an infective process and could be due to viruses or more likely bacteria. There has been some interesting work on culturing plaques and finding many of the usual culprits.https://mbio.asm.org/content/5/3/e01206-14 I believe dental hygiene is far more important than statins in preventing ischemic attacks as most bacteremias come from the gums or infected teeth (oral, throat, and sinus can also be a source as well). I have designed my own yogurt with this specifically in mind and eat 250 ml of it daily. I haven't had a cavity or gum disease in 45 years now. I believe we can adjust temporarily our oral flora and overwhelm the bad bacteria with good bacteria.Early in my career we did a bacteremia study on quantitating bacteria from blood cultures following dental procedures. It is shocking how much enters the blood stream and IMHO bad oral hygiene is likely to be similar except it is constant and not temporary such as happens after a procedure.

I am "lucky" as I have a congenital bleeding disorder and poor platelet aggregation and i don't clot for around 15-30 minutes when I cut myself. This appears to be a natural preventative for ischemic events. I have read it lowers risk to almost zero. Baby aspirin does similar things and is why it is recommended.

Yes, we are a minority.
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Old 12-10-2020, 07:00 AM   #205
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Purely anecdotal but once again I've learned my lesson. I got my cholesterol number down to the acceptable range after dropping my atorvastatin down from 20 to 10 mg. During the covid lockdown my Dr would not renew my Rx without a visit ($$$ I'm sure). I elected to forego the Rx and ended up with a right side bundle blockage. Now I'm back with 10 mg and normal lipid levels. Like I always say you have to figure it out for yourself.

Hmm, that's what happened to me, I noticed I had no more renewals on Rosuvastatin, I called to have the doc write a new one. I was told he will give you 30 days, but you need to make an appointment and have blood tests before he will extend it. For many years on other statins, I got a 1 yr prescription and blood tests once a year.

My first thought was, I went on Medicare in March, he's just milking it. Then I realized I just went on the Rosuvaststin last March, and it's probably a good idea to see how my liver is handling it. I did find Medicare will cover blood test every 3 months. PSA once a year.
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Old 12-16-2020, 08:35 AM   #206
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I just saw this video that discusses optimal LDL and All Caused Morbidity (ACM).


The LDL numbers for the lowest ACM are much higher than we normally see.
Here's one graph from the video. It shows 140mg/dl as optimal for 58 yr old men.
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Old 12-16-2020, 08:57 AM   #207
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OP here. Thanks to all who have contributed. There will never be a "one size fits all" answer. Although I am a skeptic, I plan to continue to review the literature and would happily change my mind if warranted.



If anyone has not read "Bad Pharma", they should. Of course this does not mean that all drugs are bad, or that it is bad to have obscene profits for the Pharma industry, but no one should underestimate the human capacity for greed and self-deception. When literally billions of $ are at stack, so much the more so.


I think it is reasonable to 1) not want to be on drugs if you don't have to, and 2) question the reasons for everything that your Doctor pushes. If, as happened to me and presumably others, they act put-out that you have the temerity to question them, I say that is telling.
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Old 12-16-2020, 09:01 AM   #208
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Seems like alot of docs have given up on lifestyle coaching (dont eat lard, move your body) and throw pills. ANd I think thats bc people have stopped being receptive to lifestyle coaching and want pills. WHich came first? THe chicken or the pharmaceutical salesperson who brought Olive Garden?
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Old 12-16-2020, 09:23 AM   #209
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OM, Thanks for your last few contributions to this thread. Lots of interesting points. I'll pick just one...


I knew about the dental hygiene correlation, but have not moved myself to internalize causality there (yet?). I want to take your yogurt design 101 course, hehehe! I've thought enough about oral bacteria and the concept of crowding out the bad guys to buy stuff called Florassist (or something like that), specifically designed as an oral probiotic. I need to start making fermented stuff again. Never made yogurt, but I might try that.
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Old 12-16-2020, 10:14 AM   #210
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Seems like alot of docs have given up on lifestyle coaching (dont eat lard, move your body) and throw pills. ANd I think thats bc people have stopped being receptive to lifestyle coaching and want pills. WHich came first? THe chicken or the pharmaceutical salesperson who brought Olive Garden?
Doctors aren’t trained in lifestyle coaching or nutrition. They are trained to diagnose disease and treat with prescription drugs or some procedure.

Eating lard is probably perfectly healthy. Conventional dietary advice is often quite wrong and govt nutritional guidelines are definitely wrong for most people.
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Old 12-16-2020, 10:35 AM   #211
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Doctors arenít trained in lifestyle coaching or nutrition. They are trained to diagnose disease and treat with prescription drugs or some procedure.
I'm surprised you're painting with such a broad brush audreyh1.

My doc, and many others, are trained in lifestyle coaching and suggest that if you don't like to hear their lifestyle suggestions, you find another doc. My 70# weight loss over the past few years was a result of his advise and his referral to a dietician (paid for by a Medicare program). He also has sent me to PT at times instead of just prescribing pain pills and muscle relaxers.

It's fun to blame Big Biz and the Medical Establishment for our own lack of personal responsibility, but in the end our treatment options, lifestyle choices and all that are our own responsibility.
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Old 12-16-2020, 02:58 PM   #212
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I just saw this video that discusses optimal LDL and All Caused Morbidity (ACM).


The LDL numbers for the lowest ACM are much higher than we normally see.
Here's one graph from the video. It shows 140mg/dl as optimal for 58 yr old men.
Thatís an eye-opening video. Thanks, Time2.
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