Cholesterol

[DavidTrap (David)]

CraigS,

I hadn't read your previous post before replying to the original poster.

LDL is a measured variable - whilst at Uni, I worked in a pathology lab and spent one summer working in the department that did that particular test. I think the Medicare Schedule requires the pathology lab to "measure" the variable rather than "calculate" it before they pay for the test.

I'm not sure where you evidence comes from, but elevated cholesterol is a well established risk factor for atherosclerosis. The role of LDL vs HDL cholesterol is something that has only come out in the last couple of years.

Cholesterol is a complex thing, but one of the reasons that dieting probably fails is that most people don't follow strict diets for long enough periods of time. They might think they do, but human nature causes them to return to bad habits or they are not eating the "right" diet (hence my advice to see a dietician).

Statins don't just lower cholesterol, but also "stabilises" the plaques via anti-inflammatory effects. Yes, there are side-effects to statins, but not everyone experiences those effects - like everything you do in life it is a risk-benefit analysis.

I don't claim to have all the answers.

DT

[gregbradley]

You can slam it down in 4 days. I did it once. Doctors couldn't believe it and wanted to know what I did. They said change your diet etc etc and it takes 6 weeks to notice any change. Mine was only slightly elevated.

Red rice yeast capsules, lots of water, exercise (walks on the beach nothing strenuous), salads maybe some tuna, organic lecithin twice a day, niacin (opens up the blood vessels).

Dropped something like 25%. So I disagree, diet and exercise can affect it but probably the main item was the red rice yeast.

The Naturopaths say there is no problem with higher cholesterol and its not a proven theory. Doctors don't get everything right and I agree dieticians would know more about food however they also get a lot of things right and I wouldn't go against them unless it were in an area I knew they were weak on. However is chlolesterol really a subject they are weak on? Hmm - plenty of dead people who ate lots of MacDonalds and KFC I reckon shows they are pretty close to the truth.

Greg.

[DavidTrap (David)]

I won't disagree that the pharmaceutical companies make lots of dollars from statins, but they wouldn't be subsidised on the Pharmaceutical Benefit Scheme by the Federal Government if there wasn't good evidence.

I anaesthetise patients for cardiac surgery - I certainly agree that we see lots of people who have indulged in too much fast-food. Unfortunately we see some without any risk factors who look to be clean living people - usually they have chosen their parents poorly. You can't change the hand you've been dealt, but (most of the time) you can decide how it's played. One thing I have definitely observed - 99% of the 80+ year olds we see are NOT fat - the fat ones are already dead.

DT

[MrB (Simon)]

David,
Slightly off-topic but still on the dietary theme..
What is your personal opinion on high-protien low-carb diets like BodyTrim(if you are familiar with it?)
Ketosis seems to be a concern?
Last thing I want is Acetone breath! (and other more serious ketosis effects)

[CraigS]

Originally Posted by DavidTrap

CraigS,

I hadn't read your previous post before replying to the original poster.

LDL is a measured variable - whilst at Uni, I worked in a pathology lab and spent one summer working in the department that did that particular test. I think the Medicare Schedule requires the pathology lab to "measure" the variable rather than "calculate" it before they pay for the test.

Would appreciate some first hand confirmation on whether the labs actually routinely do this for all screened samples. Happy to be corrected on this point. It wasn't always so.

LDL can be measured, but the last advice I had from a pathology lab, was that it was still calculated using the Friedewald equation. All of my historical LDL figures are within 0.5% of the calculated figure. It also varies precisely with the variance in the triglyceride figures, (which, as I mentioned, is factored into the Friedewald equation).

Originally Posted by DavidTrap

I'm not sure where you evidence comes from, but elevated cholesterol is a well established risk factor for atherosclerosis. The role of LDL vs HDL cholesterol is something that has only come out in the last couple of years.

Can you forward me the clinical trial reference papers which establish this with statistical significance?
Cholesterol is a clear risk factor for cardiac events and strokes.
Its causative role in atherosclerosis is constantly being researched. I am interested to know if any reputable trial has firmly established such a causative role.
Once again .. happy to be corrected.

Originally Posted by DavidTrap

Cholesterol is a complex thing, but one of the reasons that dieting probably fails is that most people don't follow strict diets for long enough periods of time. They might think they do, but human nature causes them to return to bad habits or they are not eating the "right" diet (hence my advice to see a dietician).

Can you forward me the clinical trial reference papers supporting the assertion that there has been a direct causal relationship established within statistical significance, between diet and serum cholesterol ? There are many so-called 'paradoxes' in this area, which support the contrary view.
Once again .. happy to be corrected in the light of quality evidence.

Originally Posted by David

Statins don't just lower cholesterol, but also "stabilises" the plaques via anti-inflammatory effects. Yes, there are side-effects to statins, but not everyone experiences those effects - like everything you do in life it is a risk-benefit analysis.

Agreed that statins act as anti-inflammatory agents.
Which is why is why I said:

Originally Posted by CraigS

If you have a confirmed, diagnosed case of artherosclerosis, or have other risk factors going against you (genetics, high blood pressure, diabetes, low measured HDL, high percentage body fat, etc), then the risk of statin therapy is probably outweighed .. so take the pills.

Cheers

[CraigS]

Originally Posted by DavidTrap

I won't disagree that the pharmaceutical companies make lots of dollars from statins, but they wouldn't be subsidised on the Pharmaceutical Benefit Scheme by the Federal Government if there wasn't good evidence.

I anaesthetise patients for cardiac surgery - I certainly agree that we see lots of people who have indulged in too much fast-food. Unfortunately we see some without any risk factors who look to be clean living people - usually they have chosen their parents poorly. You can't change the hand you've been dealt, but (most of the time) you can decide how it's played. One thing I have definitely observed - 99% of the 80+ year olds we see are NOT fat - the fat ones are already dead.

DT

David, with respect, there are many generalisations and sweeping statements you're making here.

The topic is complex, and I fully respect your professional role.

I'm happy to open my mind to the possibility that I have mis-stated something or I am way out of whack. I am fully prepared to make public apologies for any misrepresentations I've made.

However, I assure you, there is much research, deliberation and validity behind my words.

Perhaps it is not appropriate to continue in a low-rigor forum.
I am happy to call it quits at this point, if necessary.

Cheers

[DavidTrap (David)]

Craig,

I won't deny I'm making sweeping statements - basically because I feel the association between cholesterol and atherosclerosis is well established.

I'm not intending to get into an argument quoting papers. I found one whilst you were sending your most recent post, so I'll post it anyway. It's a bit old (1998), but is from the New England Journal of Medicine - reasonably well respected peer-reviewed journal. I found it in a quick google search, and I've only read the abstract, but it was pretty definite about an association (and this was an autopsy study of young people):

Association between Multiple Cardiovascular Risk Factors and Atherosclerosis in Children and Young Adults
Gerald S. Berenson, M.D., Sathanur R. Srinivasan, Ph.D., Weihang Bao, Ph.D., William P. Newman, M.D., Richard E. Tracy, M.D., Ph.D., and Wendy A. Wattigney, M.S. for the Bogalusa Heart Study
N Engl J Med 1998; 338:1650-1656June 4, 1998

Abstract can be read here

Happy to bring this discussion to an end.

As to MrB's questions about low-carb diets, if you're referring to VLCD (Very Low Carbohydrate Diets) or shake diets - there is good evidence you can drop a significant amount of weight quickly (good if you need to lose weight before elective surgery), but most people rebound when they stop.

DT

[Liz]

As a senior nurse in a Coronary Care Unit, I will chuck in my 2 cents worth.
Our cardiologists like the cholesterol level to be below 4.5, so patients with heart disease and high cholesterol are treated quite aggressively with high doses of good old Lipitor. As David says, Lipitor also has other heart friendly effects.
Cholesterol is one of the risk factors for heart disease, so if you can decrease it either by diet and/or medication, then thats great. Our docs dont reccommend the low carb/high protein diet, though I reckon its good. I lost weight 10 years ago, and dropped my cholesterol from 7ish to 4 ish by doing this. You need carbs to absorb fat.
Not everyone with a high cholesterol will get heart disease, but combined with other risk factors of blood pressure/smoking/family history/stress/weight etc., it can be a worry.
As others have said, a combination of diet and exercise normally brings it down Ok, others need different approaches per their GP.
Take care all, otherwise I will see you in CCU.

[CraigS]

Hi David;

Thanks for the link/paper. There are lots of 'ins and outs' behind this so perhaps, out of respect, and for the sake of bringing this to a quick end (for others), I am happy to let it be.

I am interested in reading more and this thread has spurred me along.

Thanks for your input.

Cheers & Rgds.

[CraigS]

Yep Liz … I agree.

All things in moderation, stay fit eat healthily, get exercise and stay away from smoking.

Statin therapy is appropriate for some who fit the risk profile.

Many things are still unknown, when it comes to the medical research behind the causes.

Cheers

[DavidTrap (David)]

Sorry if my last post seemed short or curt - my wife was giving me "the look" about the need to get the children up and into the bath...

Liz - I think the same when I look at my patients, ie I don't want to end up where they are. Then again - pork chops taste good...

DT