Here's another source of information from a pretty smart guy. Lots of medical tech talk using big words.
https://peterattiamd.com/tag/statin/
I have read a lot of Attia's stuff and, although I'm sure he is a smart guy, I find his writing to be confusing (and VERY wordy), and not all that helpful (to me, anyway) in trying to understand this stuff - particularly LDL (LDL-P, LDL-C, etc) and how important it is in assessing one's risk for CVD.
The explanation below, from Axel F. Sigurdsson MD, Ph.D., FACC (a cardiologist in Iceland), is easier for me to understand, and is consistent with a lot of other stuff I have read about LDL.
LDL-C Does Not Reflect LDL Particle Size
It has been known for a couple of decades that the
size of LDL particles may influence the risk of atherosclerosis. Studies suggest that small, dense LDL doesn’t travel alone, it typically comes along with low HDL-C and high triglycerides. This pattern has been called “lipoprotein pattern B”. Its opposite is “lipoprotein pattern A” where LDL particles are large, HDL-C often high and triglycerides low.
Interestingly, studies have shown that diets rich in saturated fat seem to increase LDL-particle size. Therefore, in theory, such diets could improve the lipid profile of individuals with small, dense LDL particles which is often associated with the metabolic syndrome. However, public health guidelines generally recommend avoidance of saturated fats as the may elevate LDL-C.
A Large Proportion of Patients with Coronary Artery Disease Don’t Have Elevated LDL-C
An
often cited study published in 2009 reported lipid measurements among 232.000 patients with coronary artery disease admitted to hospitals in the U.S. between 2000 and 2006. Almost half of these individuals had LDL-C levels less than 100 mg/dl (2.6 mmol/l) which is relatively low. However, almost 55 percent of these patients had very low levels of HDL-C (less than 40 mg/dl or 1.0 mmol/l).
The study is a reminder that low LDL-C according to current definitions does not prevent coronary artery disease. Although some scientists claim that further lowering is needed, this has still not been proven.
The current evidence, therefore, indicates that when it comes to lipids and cardiovascular prevention, relying on LDL-C is an oversimplification and will not solve any problems in the long run. Many other factors have to be taken into account. Overemphasizing the role of LDL-C in order to increase the use of statin drugs is misleading and has to stop.
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Probably the best predictor of CVD and heart attack risk (using the various lipid test results), according to numerous studies I've seen, is the Triglyceride/HDL ratio, as we have discussed before on the forum. Therefore, I can't get too concerned about LDL-C or total cholesterol, as I don't think either number tells us very much (except that you are likely to die early if you are over age 60-70, and your numbers for either one are too low).