Heart Disease risk

There is much more to it than just LDL

For at least the past few decades heart disease prevention has been about lowering LDL, know by many as “bad cholesterol”. LDL has been given that moniker because cholesterol is found in coronary artery plaques that are part of blockages that cause heart attacks.

Strange though that I do not see much research or questions about how or why the cholesterol builds up in the artery. All that seems to matter is that it is there.

Where is the curiosity as to why the LDL is in the artery wall?

One thing I have learned since my early training is that in the human body, very little is as simple as it seems.

IMW Pearl:

Heart disease prevention is not as simple as lowering LDL cholesterol.

At the IMW, we have been reviewing cholesterol profiles for many many years and have found some interesting trends/associations that make me believe that heart disease prevention should not be LDL centric. Instead I believe that while LDL is a marker to look at, there is a more sensitive marker in the lipid profile for heart disease.

Triglycerides and HDL

Let’s discuss triglycerides and the triglyceride- hdl ratio again. I discussed this before but this time don’t just take my word. Take a look at this Nature article that pretty much sums up what I have been seeing daily in my practice.

“At follow-up, the global CTA risk score (HR 1.06, 95% confidence interval (CI) 1.03–1.09, P = 0.001) and the IV quartile of the TG/HDL-C ratio (HR 2.85, 95% CI 1.30–6.26, P < 0.01) were the only independent predictors of the primary outcome. The TG/HDL-C ratio and the CTA risk score progressed over time despite increased use of lipid-lowering drugs and reduction in LDL-C. In patients with stable angina, high TG and low HDL-C levels are associated with CAD related outcomes independently of LDL-C and treatments. ”

Let me translate:

CTA is an angiogram of your coronary arteries done via Cat Scan. It’s a less invasive visualization than a cardiac catheterization.

TG = Triglycerides

HDL-C = High Density Lipoprotein cholesterol known as good cholesterol

LDL-C = Low Density Lipoprotein cholesterol known as bad cholesterol

The study results indicated:

Of the above markers, only CTA risk score and Trigs/HDL ratio predicted future heart disease risk.

Both of the above still progressed or increased risk with time EVEN IN PATIENTS USING LDL CHOLESTEROL LOWERING DRUGS.

LDL by itself did not predict heart events.

Question:

If LDL by itself did not predict heart disease events and neither did lowering LDL with meds, why are we still so singularly focused on lowering LDL with statins or the new PCSK9 inhibitors to prevent heart disease?

Why not instead focus on what we can do to lower the Trig/HDL ratio?

To lower this ratio we want to lower the triglycerides and raise the HDL.

Luckily one dietary intervention accomplishes both. Can you guess what that is?

I’ll tell you.

LOWER YOUR DIETARY CARBOHYDRATES

Lowering this ratio improves your insulin sensitivity. Having healthy insulin sensitivity helps to prevent obesity, hypertension, heart disease, strokes and cancer.

We used to think the earth was flat.

Last time I checked it was not.

We seem to think that a singular focus on LDL is the cause of all woes in healthcare.

Well it is not.

My belief is traditional heart disease prevention is chasing the wrong boogeyman. But as long as medical training and funding is captured by those selling prescription drugs and other medical treatments, it will still be full steam ahead with lowering LDL. If you are on that train beware. Look out for the cliff ahead of you.

Find someone knowledgeable in helping you improve your Insulin Sensitivity. It will do more than just prevent heart disease. A whole lot more. But that should be a topic for another time.