Harvard Health: Cholesterol testing is seriously flawed

[chassis]

Has anyone read this article or anything similar? https://www.health.harvard.edu/heart-health/c-reactive-protein-test-to-screen-for-heart-disease

The article is from 2017.

People in my circle who are athletes, good BMI, good diet, no drinking, no smoking, etc. have high cholesterol, specifically high LDL. But low C-Reactive Protein, an inflammation marker.

The article says, "But for all its virtues, cholesterol testing is seriously flawed. Research has shown that only about 50% of the people who have heart attacks have high LDL. If LDL levels are supposed to be an alarm, then it's not going off for half of those who might benefit from a wake-up call."

Is the medical community changing its view on the relationship of cholesterol and heart disease?

What do all y'all think about this?

 

[BobTomas]

From my experience it is moving more towards looking at the size distribution of the cholesterol particles in addition to just the numbers (I was a scientist in medical diagnistics, but can also google it). Plus having high HDL is important and the ratios.

 

[bloom2708]

How many have high cholesterol and all other areas are "fine"?

I do think people really like reports that "cholesterol doesn't matter" because it allows you the "whew" when you have high cholesterol..well..one less thing to worry about.

 

[f35phixer]

From my experience it is moving more towards looking at the size distribution of the cholesterol particles in addition to just the numbers (I was a scientist in medical diagnistics, but can also google it). Plus having high HDL is important and the ratios.

my dr said he was going to do this test for size too. I do have high C, was on pravastatin and after a while, felt like i was getting STUPID, the big A and D run in the family. Did cognitive and Cat scans of brain all looked good. Dr took me off for 6 months and felt like I could function again. Then put me on Ezetimibe and all was fine ~ 2years, recently though i again am feeling like i'm getting stupid again;-( So he said was going to look at size of particles....

 

[audreyh1]

I’m glad you are able to monitor your brain fog and that your doctor listens.

 

[googily]

The rise of coronary artery calcium (CAC) scans is starting to be seen as an adjunct to cholesterol test results. While some commentators talk about ignoring LDL altogether, others say that a high LDL by itself (especially if you have high HDL and low trigs) may be less concerning especially if you have a zero CAC score. But hopefully the days of "OMG high LDL here's your statin" are coming to a close.

 

[OldShooter]

I fully expect that a "popular science" type article from four years ago has been considered with the respect due to it.

I am confident that the medical profession continues conduct research and to optimize treatment protocols based on that research. I pay my doctor to know about this stuff. It is not possible for me to do enough competent research to become qualified to second-guess the medical consensus.

 

[ceciledian]

From my experience it is moving more towards looking at the size distribution of the cholesterol particles in addition to just the numbers (I was a scientist in medical diagnistics, but can also google it). Plus having high HDL is important and the ratios.

My PCP tested my cholesterol particles years ago and I passed with the big fluffy particles. My ratio has always been good even though my total cholesterol is high and my HDL is kind of ridiculously high. I saw a cardiologist three years ago and he discounted the particle size as an invalid argument against statins and desperately wanted me to start at 40 mg of lovastatin. I’m taking my chances without statins even though heart disease is rampant in my family. I have a far healthier and active lifestyle than my prematurely deceased relatives.

 

[Freedom56]

I have been getting my CRP tested for the past 20 years as part of my annual physical blood test. It has been consistently been below 0.3 mg/dL vs the reference of <0.8 mg/dL. My LDL Cholesterol has been in the range of 107-114 and HDL in the range 52-60. My doctor saw no reason to prescribe statins to bring my LDL below 100. I take vitamin D and Biotin daily.

 

[chassis]

I have been getting my CRP tested for the past 20 years as part of my annual physical blood test. It has been consistently been below 0.3 mg/dL vs the reference of <0.8 mg/dL. My LDL Cholesterol has been in the range of 107-114 and HDL in the range 52-60. My doctor saw no reason to prescribe statins to bring my LDL below 100. I take vitamin D and Biotin daily.

Great numbers @Freedom56. What do you chalk them up to? Diet? Exercise? Genetics? Something else?

 

[RAE]

Cholesterol is pretty worthless as an indicator of heart disease risk. There are many, many articles in the literature on this topic, but as with many other things, the medical community is very, very slow to recognize this and make changes. It is pretty widely recognized now that heart disease is largely the result of chronic inflammation. That chronic inflammation is often the result of long-term damage to the heart and other parts of the body due to insulin resistance - which occurs as a result of poor diet (too many refined carbs, too many industrial seed oils, high-fructose corn syrup, etc - too many junk foods in general).

This article explains it fairly well: World Renowned Heart Surgeon Speaks Out On What Really Causes Heart Disease — myscienceacademy.org

 

[ugeauxgirl]

Cholesterol is pretty worthless as an indicator of heart disease risk. There are many, many articles in the literature on this topic, but as with many other things, the medical community is very, very slow to recognize this and make changes. It is pretty widely recognized now that heart disease is largely the result of chronic inflammation. That chronic inflammation is often the result of long-term damage to the heart and other parts of the body due to insulin resistance - which occurs as a result of poor diet (too many refined carbs, too many industrial seed oils, high-fructose corn syrup, etc - too many junk foods in general).

This article explains it fairly well: World Renowned Heart Surgeon Speaks Out On What Really Causes Heart Disease — myscienceacademy.org

I'm interested in the article but it's a bad link

 

[oldtrig]

My cholesterol has always been around 150 and I take no medicine. Last month is was 130.

TRIGLYCERIDES 56
LDL 84

My HDL was lower than in the past years though at 39. One year ago it was 56 .

For some odd reason about 6 months ago I developed a heart skip. Off to my first ever heart doctor.

Went through all the test and found out after a heart scan that I was not as good as I thought I was.

A score of 100 to 300 means moderate plaque deposits. It's associated with a relatively high risk of a heart attack or other heart disease over the next three to five years. My score was 260 which puts me at risk yet the doctor didn't seem concerned .

Now I am confused on why they have been testing my cholesterol every year and never once suggested the heart scan.
I only take B/P meds and heart doc suggested I take a baby aspirin each day now.

He said he could probably fix my heart skip which sometimes is pretty bad with a Beta Blocker but said because my heart rate is low at night he wouldn't put me on that medicine.

I did wear a heart monitor for three days and I assume that is how they knew about my heart rate at night. The palpitations are annoying to say the least. They are still with me after 6 months and its seems as it started all of sudden. At least I never felt anything different but I do now.

I will be 74 in 8 days so maybe they think I am old and figure I have lived a full life.

I may seek a 2nd opinion on this one. I forgot to add that they had me do the ultra scan of my heart also. The tech wouldn't shut up while he was doing it and he all of sudden said sir , did you know your heart was skipping pretty bad. I told him no, that I just wanted to visit the doc lol

 

[chassis]

Regarding cholesterol and its relation to coronary artery disease and specifically atherosclerosis.

Why don’t we just cut to the chase and use CT and angiography from the start? This is the gold standard to assess arterial plaque, correct?

It seems a long way around the barn to use years of cholesterol tests, and possibly unnecessary use of statins, when the shortest distance from point A to point B is imaging the coronary arteries.

If I could self order CT and angiography, and the self-pay cost was palatable I would do it. So far I haven’t seen this as a self-directed retail option for patients.

 

[oldtrig]

Regarding cholesterol and its relation to coronary artery disease and specifically atherosclerosis.

Why don’t we just cut to the chase and use CT and angiography from the start? This is the gold standard to assess arterial plaque, correct?
It seems a long way around the barn to use years of cholesterol tests, and possibly unnecessary use of statins, when the shortest distance from point A to point B is imaging the coronary arteries.
If I could self order CT and angiography, and the self-pay cost was palatable I would do it. So far I haven’t seen this as a self-directed retail option for patients.

I was told if I went to one certain hospital I would get reimbursed what I pay them. I had to drive 50 miles one way.



I asked how much they charged at our local hospital and they told me $130.



I paid the money because I hate driving and it was lower stress on me being my wife had just broke her hip .



I also have the best medicare supplement out there but they wouldn't pay for something I think would tell a person just how healthy their heart is.

 

[zinger1457]

You can get a Coronary Calcium Scan at a reasonable cost at some locations, got one maybe 4 years ago and it was under $100 self pay, no insurance involved.

 

[chassis]

You can get a Coronary Calcium Scan at a reasonable cost at some locations, got one maybe 4 years ago and it was under $100 self pay, no insurance involved.

@zinger1457 Thanks! Yes, this is what I am looking for. I have done some searching online and haven’t found a facility near me that offers this. I will keep digging.

 

[Freedom56]

Great numbers @Freedom56. What do you chalk them up to? Diet? Exercise? Genetics? Something else?

I suppose keeping my BMI between 23 and 23.5 since my 20's helps. Seeing the same doctor once a year for my physical for the past 23 years helps guide my health. Seeing a dentist regularly also helps. Poor dental health can cause serious health issues. I stay active with daily exercise (cycling, running, hiking, swimming). I don't follow any diets but I avoid buffets, deep fried foods, and desert. I don't smoke and rarely drink alcohol. Genetics plays a role. My parents are in their mid 80's and still mobile but they started slowing down when they turned 80. Having a nurse at home (my wife) also helps.

 

[RAE]

I'm interested in the article but it's a bad link

Hmmm, link works for me...........let's try again: World Renowned Heart Surgeon Speaks Out On What Really Causes Heart Disease — myscienceacademy.org

 

[Aerides]

I suppose keeping my BMI between 23 and 23.5 since my 20's helps. Seeing the same doctor once a year for my physical for the past 23 years helps guide my health. Seeing a dentist regularly also helps. Poor dental health can cause serious health issues. I stay active with daily exercise (cycling, running, hiking, swimming). I don't follow any diets but I avoid buffets, deep fried foods, and desert. I don't smoke and rarely drink alcohol.

That could describe my Dad, except at 76 he's not quite as active as you. Still, walks daily and swims. He's always had cholesterol over 200, usually as high as 240. Makes no sense. He gave up and started statins at 70.

 

[RAE]

My cholesterol has always been around 150 and I take no medicine. Last month is was 130.

TRIGLYCERIDES 56
LDL 84

My HDL was lower than in the past years though at 39. One year ago it was 56 .

For some odd reason about 6 months ago I developed a heart skip. Off to my first ever heart doctor. l

I developed a heart skip (technical name for mine was PVC........premature ventricular contraction) several years ago. Just annoying at first, but eventually it got to the point where I could not sleep at night, as the irregular/hard heartbeats were keeping me awake. I went to the doctor, and had all the heart tests, including an electrocardiogram - everything turned out fine (except the PVC was still there). Doctor had no answer as to why it was happening. So I did my own research, and found out one possible cause for this was too much iron in your system..........iron overload. Went back and had my iron tested (serum ferritin test........simple blood test, inexpensive, insurance covers it). Found out my serum ferritin was over 450, which is sky high! The best way to reduce iron is to donate blood, so I started doing that, and the problem gradually went away. Got my serum ferritin down to under 100 now, and the heart is fine, no more issues. I now donate blood 3X yearly to keep my ferritin where it should be. Some people have a tendency to accumulate too much iron over time, and I am apparently one of them. It's actually not all that uncommon.

 

[Sojourner]

I developed a heart skip (technical name for mine was PVC........premature ventricular contraction) several years ago. Just annoying at first, but eventually it got to the point where I could not sleep at night, as the irregular/hard heartbeats were keeping me awake. I went to the doctor, and had all the heart tests, including an electrocardiogram - everything turned out fine (except the PVC was still there). Doctor had no answer as to why it was happening. So I did my own research, and found out one possible cause for this was too much iron in your system..........iron overload. Went back and had my iron tested (serum ferritin test........simple blood test, inexpensive, insurance covers it). Found out my serum ferritin was over 450, which is sky high! The best way to reduce iron is to donate blood, so I started doing that, and the problem gradually went away. Got my serum ferritin down to under 100 now, and the heart is fine, no more issues. I now donate blood 3X yearly to keep my ferritin where it should be. Some people have a tendency to accumulate too much iron over time, and I am apparently one of them. It's actually not all that uncommon.

Thanks for posting this. I have PVCs, too, but my cardiologist never mentioned anything about serum ferritin. He did say to stay away from caffeine and other stimulants and to make sure I was getting enough magnesium in my diet, yet the PVCs have persisted for years now even after following this advice pretty diligently.

Definitely going to look into serum ferritin and donating blood.

 

[OldShooter]

... Definitely going to look into serum ferritin and donating blood.

Based on one anecdote from SGOTI? You guys crack me up.

 

[Aerides]

DH has hemochromatosis (high ferratin) but it didn't present any heart stuff. Showed up in a couple of borderline blood tests which led to more tests and more tests before diagnosis. Left untreated it can cause serious organ issues.

But it's not terribly common. More in men than women, and shows up usually after 50. He has phlebotomies done via his doctor, and has his ferritin retested every 90 days or so. Avoids iron intake where practical.

 

[MrsHaloFIRE]

From my experience it is moving more towards looking at the size distribution of the cholesterol particles in addition to just the numbers (I was a scientist in medical diagnistics, but can also google it). Plus having high HDL is important and the ratios.

Yes my BIL had an NSTEMI with good cholesterol and flawless EKG. Turns out it was bad sized cholesterol. And his stress tests etc were fine. He had an artery that was apparently completely closed that had developed its own excellent bypass. Very strong good heart. 3 stints. Damnedest thing. Young. Genetic history of young heart attacks. Scared the pee out of us. 2 LITTLE kids. Prayers appreciated.