Why LDL cholesterol doesn't mean a thing

I hope everyone here has watched the excellent Cereal Killers film. After being on a low carb high fat diet the presenter had lots of tests to check out if the diet had negatively affected his health. All tests showed great improvements, but one alarm bell was ringing, his LDL cholesterol, the so called bad cholesterol had gone up markedly.

After further investigation he was given the all clear, after measuring LDL particle sizes they were found to be the large type which are considered safe. Here is my point, it is almost always the case when on a low carb high fat diet Trigs plummet and HDL the so called good cholesterol goes up. This is great and shows our diet is safe, but LDL often goes up, which some say is bad. But here is the rub, although we have lipid tests, as far as I know the NHS does not ever do a particle size test, therefore the LDL number we get is completely pointless, it tells us nothing.

BTW The new American College of Cardiology/American Heart Association, dumped LDL targets for measuring target levels and basing recommendations on a patient's risk of cardiovascular events some time ago, as can be read at the link below.

Anyone here ever had an LDL particle size blood test and if so what did if prove ?

http://www.aafp.org/afp/2014/0815/p223.html

The particle count/size assays aren't available in Oz - don't think they are available in the UK either?

I think the two I've heard about are called NMR and VAP.

The importance of particle size seems to be far from settled as well according to stuff I've read elsewhere.

No, and this is the very point my consultant is making; my trigs are low, my HDL is high but so is my LDL. So, I must have a statin...

It's exhausting having to constantly battle against this, and to be honest I'm wavering a bit. The consultant claimed that for Type 1 diabetics the chances of heart attacks went down by 60% with statins. I can't find any study that suggests anything like that level of reduction; the normal levels are all pretty much expresses as 30% reduction (relative risk) which works out at about 1 or 2% in absolute terms.

There is some very slight benefits at those sorts of levels (i.e. c. 2% in absolute terms) for some diabetic complications but I bet having a lower HbA1c does far more than that.

Best

Dillinger

The other test that's available in the States but not sure if available in our countries is the calcium score - they do a scan that checks the coronary arteries for calcifications. It's supposed to be a more accurate method of assessing your CVD risk than lipid panels.

Your consultant should be able to substantiate that 60% figure rather than you having to do the leg work.

In any event, aren't we at risk of confusing 'population statistics' with individual cases? It may even have been yourself Dillinger who pointed this out some months ago over on DCUK. By doing what you're doing you put yourself at the 'good' end of the curve.

But I don't think we can get LDL particle size done here, not on the NHS at any rate.

Dillinger said

"There is some very slight benefits at those sorts of levels (i.e. c. 2% in absolute terms) for some diabetic complications but I bet having a lower HbA1c does far more than that."

The most important number for a diabetic is HbA1c when that is in the safe zone so many other factors become safe.

For every percentage point drop in A1C blood test results (from 8.0 percent to 7.0 percent, for example), the risk of diabetic eye, nerve, and kidney disease is reduced by 40 percent. Lowering blood sugar reduces these microvascular complications in both type 1 and type 2 diabetes. Intensive blood sugar control in people with type 1 diabetes (average A1C of 7.4%) reduces the risk of any CVD event by 42 percent and the risk of heart attack, stroke, or death from CVD by 57 percent.

Source: DCCT/EDIC, reported in December 22, 2005, issue of the New England Journal of Medicine.

eddie1 wrote:

For every percentage point drop in A1C blood test results (from 8.0 percent to 7.0 percent, for example), the risk of diabetic eye, nerve, and kidney disease is reduced by 40 percent. Lowering blood sugar reduces these microvascular complications in both type 1 and type 2 diabetes. Intensive blood sugar control in people with type 1 diabetes (average A1C of 7.4%) reduces the risk of any CVD event by 42 percent and the risk of heart attack, stroke, or death from CVD by 57 percent.

Source: DCCT/EDIC, reported in December 22, 2005, issue of the New England Journal of Medicine.

What's interesting about that is that the reduction is from HbA1cs of about 9.0% and the 'intensive' blood sugar control means an HbA1c of about 6.9% - so if we are getting around 6.0% or below then I wonder if the risk reduction continues? It seems to make sense that it does based on non-diabetic blood sugars, but my ever helpful consultant was saying that the lower you go below 6.0% the higher the risk for heart health, but again I've never ever seen ANYTHING like that expressed anywhere (in the form of a study or even any analysis); has anyone else?

Best

Dillinger

Dillinger wrote:

eddie1 wrote:

For every percentage point drop in A1C blood test results (from 8.0 percent to 7.0 percent, for example), the risk of diabetic eye, nerve, and kidney disease is reduced by 40 percent. Lowering blood sugar reduces these microvascular complications in both type 1 and type 2 diabetes. Intensive blood sugar control in people with type 1 diabetes (average A1C of 7.4%) reduces the risk of any CVD event by 42 percent and the risk of heart attack, stroke, or death from CVD by 57 percent.

Source: DCCT/EDIC, reported in December 22, 2005, issue of the New England Journal of Medicine.

What's interesting about that is that the reduction is from HbA1cs of about 9.0% and the 'intensive' blood sugar control means an HbA1c of about 6.9% - so if we are getting around 6.0% or below then I wonder if the risk reduction continues? It seems to make sense that it does based on non-diabetic blood sugars, but my ever helpful consultant was saying that the lower you go below 6.0% the higher the risk for heart health, but again I've never ever seen ANYTHING like that expressed anywhere (in the form of a study or even any analysis); has anyone else?

Best

Dillinger

http://annals.org/article.aspx?articleid=717819

The relationship was apparent in persons without known diabetes. Persons with hemoglobin A1c concentrations less than 5% had the lowest rates of cardiovascular disease and mortality. An increase in hemoglobin A1c of 1 percentage point was associated with a relative risk for death from any cause of 1.24 (95% CI, 1.14 to 1.34; P < 0.001) in men and with a relative risk of 1.28 (CI, 1.06 to 1.32; P < 0.001) in women. These relative risks were independent of age, body mass index, waist-to-hip ratio, systolic blood pressure, serum cholesterol concentration, cigarette smoking, and history of cardiovascular disease.

yoly wrote:

http://annals.org/article.aspx?articleid=717819

The relationship was apparent in persons without known diabetes. Persons with hemoglobin A1c concentrations less than 5% had the lowest rates of cardiovascular disease and mortality. An increase in hemoglobin A1c of 1 percentage point was associated with a relative risk for death from any cause of 1.24 (95% CI, 1.14 to 1.34; P < 0.001) in men and with a relative risk of 1.28 (CI, 1.06 to 1.32; P < 0.001) in women. These relative risks were independent of age, body mass index, waist-to-hip ratio, systolic blood pressure, serum cholesterol concentration, cigarette smoking, and history of cardiovascular disease.

Great info! Thank you; I'm going to change consultant!

Best

Dillinger

http://annals.org/article.aspx?articleid=717819

The relationship was apparent in persons without known diabetes. Persons with hemoglobin A1c concentrations less than 5% had the lowest rates of cardiovascular disease and mortality. An increase in hemoglobin A1c of 1 percentage point was associated with a relative risk for death from any cause of 1.24 (95% CI, 1.14 to 1.34; P < 0.001) in men and with a relative risk of 1.28 (CI, 1.06 to 1.32; P < 0.001) in women. These relative risks were independent of age, body mass index, waist-to-hip ratio, systolic blood pressure, serum cholesterol concentration, cigarette smoking, and history of cardiovascular disease.

What a find yoly, it makes perfect sense, the nearer we can get to non diabetic BG numbers the better our outcomes. That being said, it has been proved ramming high BG numbers down with a high meds regime is a disaster. The ACCORD study proved it.

The American Heart Association recently abandoned LDL targets, according to some comments I've read they are saying there is no scientific basis to support treating to LDL targets one even said they were plucked out of thin air