I'm fairly well read on the subject of cholesterol and CAD risk but am having a difficult time assessing risk based on the confusing and ever changing norms. I'd love some input regarding what I see as huge discrepancies in the various measures of risk presented by a number of experts.

When I first began tracking, TC and LDL was all that a doctor looked at. Then a high HDL became a significant protective measure, even if the TC & LDL were high and low triglycerides were also deemed important.

Additional research indicated that homocysteine levels were a significant factor. Later, inflammation levels, measured by a C-Reactive Protein blood test (C-RP) was indicated to be the true measure of high risk.

After some time, the be-all, end-all was said to be particle size. A person would either be Pattern A (large fluffy and non-atherogenic) or Pattern B (small dense and trouble). This is still widely spoken of, most recently in "The Great Cholesterol Myth" by Bowden/Sinatra (a cardiologist).

Many say that ratios of TC, LDL, HDL, etc. are really a better indicator of risk.

Most recently, a number of doctors (Dayspring, Attia, among them) have said to forget Pattern A or B particle size, etc. ......and that LDL particle COUNT (LDL-P) is the onlyl significant measure. Apparent docs like Sinatra don't agree.

Which brings me to my dilemma. Some of my labs (listed below) indicate low risk, others quite high. I'm at a loss as to how to resolve it. I'm thinking of seeing a cardiologist in hope that they can sort it out, although I suspect the doc could be as confused as I, as much new research seems to be conflicting. Anyone want to offer a diagnosis?

This is a recent NMR lab primarily done to measure LDL-P:
TC 260 ( high over 200)
LDL direct 171 (high over 100)
HDL 81 (desirable over 40)
Trigs 40 (desirable under 150)
LDL-P 1918 (high is 1600-2000)
Insulin Resistance Score :10 (desirable under 45)

A previous VAP gave me ballpark TC, LDL, HDL & trigs but also these:
CRP of .23
LDL Density Pattern: A
Homocysteine: 5.6 (desirable under 10)

Ratios are excellent:
TC/HDL: 3.2 (should be lower than 5)
LDL/HDL: 2.1 (should be lower than 4.3)
Trigs/HDL: .49 (should be lower than 2)

So it seems lopsided. And I haven't a clue what value are most significant. And research in this area seems to change quickly. One thing for sure: I am not going to take a statin.

If you're really concerned, have a coronary calcium scan for about $100.

Jimmy Moore has really high LDL cholesterol and his score is zero. A very unusual score for a man his age.

There was some pretty good stuff in "Wheat Belly" about cholesterol.

Thanks, Nancy. I'm thinking that may be another good reason to consult a cardiologist. I know my internist doesn't understand any of these nuances. He only focused on TC and thinks everyone should take statins.

I am exactly at this point myself. I am currently reading the book by Bowden & Sinatra and some of the blog entries on cholesterol by Attia ... and trying to make sense of it all. I wonder where the new book by Jimmy Moore & Eric Westman will come down on this issue??

Thanks
Glenn in Omaha

Only one more day and the world will know. In the meantime, focus on last point:

Within the pages of this book you'll learn invaluable lessons, including:
Why your LDL-C and total cholesterol numbers may not be as important in determining your health as your doctor may think
The undeniable negative role chronic inflammation plays in your health
Why cholesterol-lowering statin drugs don't necessarily solve your heart health concerns
Why your doctor should be testing for LDL particles and particle size
Why HDL and triglycerides are far more predictive of health concerns than LDL-C and total cholesterol
Why consuming saturated fat is good and why carbohydrates are detrimental to attaining the best cholesterol numbers
Why there is a growing number of physicians, researchers and nutritionists who believe treating cholesterol numbers is virtually irrelevant


Also, the interviews Jimmy has been posting have been very interesting.

Hi JEY!

I haven't ordered it but maybe I should.

I've implemented some of the Bowden/Sinatra recommendations and will have followup bloodwork in a few weeks.

I hope all is great with you!

Wow! I think those numbers are great.

I wouldn't care about the TC if my other numbers were that good.

Hi Jan!
All is great here...been a wonderful, relatively cool summer, and we are headed to Cape Cod tomorrow for DH's 65th BDay, so partytime with friends who have retired there. Uh-Oh....I'll have to be on the straight and narrow when I return. Hope all is well with you too (and your friend)

The Kindle edition of CC is now available, book is temporarily out of stock as all the pre-orders leave the warehouse. Three previewer reviews are up, all 5 star.

And to Add later...

My husband just returned from his annual physical with his NMR scores. The doctor wasn't concerned about his 280 total cholesterol and 193 LDL, because his HDL was 77 and Trigs 50 with IR of 8! What? This doctor is just a regular PCP in private practice in Raleigh...not anyone at Duke. Knock me over with a feather...he completely understood what is and is not important...things are definitely changing. We had sent him the link to Cholesterol Clarity but he obviously hasn't read it yet...but he has been reading and agreeing with other info we have sent before. Said my DH is a rare creature entering his Medicare practice.... thin, exercises, not being treated for anything, and no meds....(thanks to his wife :-))

Since you were concerned about LDL-P, that went from 1785 down to 1468....but he was very careful about what he ate and no alcohol the week before the draw. http://blog.trackyourplaque.com/201...-particles.html
And listen to Dr. Lundell's interview with JM...he doesn't bother with it and thinks Attia has the significance of LDL-P wrong.

JEY - Congrats to your husband on great numbers...and also on finding a sane and up-to-date M.D.!

Thanks also for the link. Have a wonderful time on Cape Cod!

That is great news, JEY! My husband has had consistently "high" cholesterol for some time (240 ish) , and while doctors usually recommend he take a statin, they back down quickly when they look at his HDL and trigs (in the same range as your husband's). I think there are a number of doctors who agree with us but are under pressure from CW/Best Practices crap.

I ordered my copy of CC in June and, sadly, just this morning got a notice that my copy is back-ordered with no proposed ship date. Glad to know I can just download to my iPad in the meantime.

oops, duplicate post