Cholesterol

[Matt6096]

Hi all, just got a cholesterol blood test result and I’m a little confused as to whether it’s bad or not. My HDL is 2.44 and my LDL is 3.5, is this a worrying result? Any help figuring this out would be greatly appreciated.

[DavidG1971]

My overall was 6.3 and was deemed too high.

[Chappychap]

Your total cholesterol is a bit high, but the opinion of my doctor (and a view that I'm reading from a lot of experts) is the single most important lipid level metric is the ratio of total cholesterol to HDL cholesterol. You really want a number below 4.0, and anything above 6.0 (some experts say 5.0) is a red flag.

Your ratio is about 2.4 and that's pretty good. My score is now similar, but I needed statins, niacin supplements, a rigorous diet, and plenty of exercise to get there!

[Matt6096 in reply to Chappychap]

Thanks for the info, the thing is I have a pretty good diet, exercise 5 days a week and I don’t smoke or drink. I’m not sure what else I can do to lower it without medication.

[Chappychap in reply to Matt6096]

For some people lifestyle isn't enough, they also need medication. There are no shortage of whip thin marathon runners having heart attacks and strokes.

[Matt6096 in reply to Chappychap]

Very true.

[Dickydon in reply to Matt6096]

Just live your life as you wish and feel comfortable with. Overreacting often causes the problem that we’re always worrying about.

Back in the summer, two obviously extremely fit 30 somethings, collapsed and died at a marathon in Wales. How does that work out one wonders?

Yet I’ve known people do die naturally into their 80’s and they were heavy drinkers, smokers, dreadful diet, no exercise etc... and one I know of who came in that category and died in his sleep recently, he’d had some blood tests a few months prior to death and doctor couldn’t believe how perfect everything was and he was a smoker, drinker, poor diet, etc... and was 88 and had been drinking and smoking since he was 14. Compare that to your diet and fitness freaks who panic at every breath!

[Paul12 in reply to Dickydon]

Marathons are known heart risks

[jobe1968 in reply to Chappychap]

Interested in the niacin. Did it help raise your HDL and at what dose?

[Chappychap in reply to jobe1968]

I believe Niacin has helped me, but that's risking what researchers sometimes call the "n=1 fallacy", ie basing a conclusion on just one person...yourself!

Better to look at the actual test results. Normally supplements don't get properly tested because the supplement can't be patented, so there's no incentive to invest the money into the proper randomised, double-blind test programmes that would give a conclusive answer.

However, Niacin is slightly different, it causes most people to flush or blush when they take it, so there's been medical tests into versions of Niacin with anti-flushing agents. The results have shown Niacin is definitely effective in reducing total cholesterol and improving the HDL ratio (especially when taken in conjunction with a low dose statin), and it's also effective in reducing blood pressure. The problem from the pharmaceutical company's perspective is that even though Niacin worked, their anti-flushing version didn't actually reduce flushing! Consequently, no Niacin based drugs have ever been released.

This is a shame, the NHS used to prescribe Niacin but NICE has removed their endorsement because of this flushing issue. It should be emphasised that flushing poses absolutely no health risk, but many people find it embarrassing so they stopped taking the medication, which is why NICE concluded that it wasn't worth prescribing.

There are slow release versions of Niacin available which can substantially reduce flushing, and you may be one of that substantial minority of people (as I am) who aren't affected by flushing. I'm normally very sceptical about supplements, which often seem more about old wives tales and desperation than scientific research, but Niacin is one of the very few exceptions that I'd seriously consider.

[Fortepiano in reply to Chappychap]

NICE ruled against niacin because it doesn't actually reduce cardiovascular risk. There was a meta analysis in 2014 in the BMJ which concluded:

'Conclusions Neither niacin, fibrates, nor CETP inhibitors, three highly effective agents for increasing high density lipoprotein levels, reduced all cause mortality, coronary heart disease mortality, myocardial infarction, or stroke in patients treated with statins. Although observational studies might suggest a simplistic hypothesis for high density lipoprotein cholesterol, that increasing the levels pharmacologically would generally reduce cardiovascular events, in the current era of widespread use of statins in dyslipidaemia, substantial trials of these three agents do not support this concept.'

The THRIVE trial found an added risk of bleeding and infection with niacin. It's not recommended in the US either.

[Hidden]

Interesting. Is that generally accepted?

[Camelliared]

Mine came down to 3.1 in 2 months from 5.2 after heart attack and stent. Drs. we’re aiming for 4.1 . Medication and diet changes did the job. Low fat, low sugar and low salt. Hope that helps.

[jobe1968 in reply to Camelliared]

Mine dropped from 7.1 to 2.8 with avorstation and some major lifestyle changes.

I have tried niacin and experience the flush however it passed quickly. My interest is in raising HDL however some studies show HDL raised by medication does not have the same beneficial effects.

My ldl is now around the 1.5 mmol level so I am happy with that. HDL up from 0.82 last August to 1.26 beginning of Jan. Ideally I would hope to get this to 1.6

As I have read some research indicating low levels of LDL can reduce risk of a second event my target is to maintain this low LDL and strive to improve HDL.

Triglycerides improved markedly also so the drugs and diet/exercise seem to be effective

[Paul12]

Get a PLAC test to analyse the LDL. But in answer to your question - no

[Paul12]

I have seen statins mentioned twice. It might be an idea to visit the Facebook group Stopped Statins and read a bit. It’s a U.K. forum and tightly moderated

[Hidden]

My overall cholesterol is 7.0 (7.1). HDL is 1.4, LDL is 5. Overall down 0.1 from last year. Still didn’t stop the ‘contact GP urgently to discuss’ letter. Have family history on Mother’s side of high cholesterol which was controlled by statins. At the moment nothing about my diet needs changed, I don’t smoke, I very seldom drink alcohol. The exercise situation could be better but because of the LDL number and lifestyle even at age 57 the GP doesn’t think I need statins to get overall level lower. I’m happy with this as I don’t want to be on anybody medication if at all possible.