To Take Statins or Not - That is the Question - Here is the Answer:

[sos007]

Utilizing the standard cholesterol lipid panel alone cannot provide you with an assessment of your overall health. However certain things can be determined. If your objective is to minimize the risk of cardiovascular disease then it is best to keep (TG) triglycerides (fat in the blood generated by the consumption of simple carbohydrates, especially sugar) as low as possible.

"Elevation in the ratio of TG to HDL-c was the single most powerful predictor of extensive coronary heart disease among all the lipid variables examined."*

*Source: medical study: ncbi.nlm.nih.gov/pmc/articl...

As a general guide, you optimally want your triglycerides below 0.8 mmol/l.

HDL-C initiates a process called 'reverse cholesterol transport' and helps clear LDL-C from the body. Optimally, you want to have this value above 1.55 mmol/l.

Overall, the ratio of TG/HDL should be <0.87.**

**Source: docsopinion.com/2014/07/17/...

By lowering your TG, you will automatically lower your LDL-C, but more importantly, you will lower LDL-P (particle number) which is a more relevant CVD risk metric than LDL-C.^

^Source: ncbi.nlm.nih.gov/pmc/articl...

Other behaviours that will lower LDL-P and triglycerides include, exercise, a low carbohydrate diet and increased intake of omega-3 fatty acids.##

##Source: lipid.org/sites/default/fil...

Omega 3 fatty acids are abundant in cold-water fish such as wild-caught salmon as well as in extra-virgin olive oil, and walnuts among other foods.

A low carbohydrate diet will force your body to burn more body fat for fuel and will result in fat loss, and likely overall weight loss which will also lower your blood pressure and the burden placed on your heart.

General heart-healthy guidelines:

If you smoke, quit. If you drink alcohol, limit consumption to 3 glasses per week. Avoid processed foods, avoid juices and soft-drinks, and avoid sugar. Eat more vegetables, legumes (beans, chick peas, green peas, lentils, almonds), berries, and especially leafy greens and cruciferous vegetables like arugula and broccoli.

Exercise daily - target at least 30 to 60 minutes for a brisk walk.

Sugar is toxic to the human body, in the short term by negatively impacting your gut microbiome and in the long-run by creating an inflammatory state in your arteries that result in an immunological response by your body which triggers the process of atherogenesis.***

*** futurity.org/sugar-gut-bact...

and ncbi.nlm.nih.gov/pmc/articl...

To make changes to your dietary and lifestyle habits it is necessary to initiate an accountability process. For lifestyle, get a wearable fitness tracker like a Fitbit or equivalent product. For dietary accountability, get a quarterly blood-test to monitor changes in your biomarkers.

Other important biomarkers for CVD risk include:

- LDL-P or ApoB

- homocysteine

- fibrinogen

- Lp-pla2 or PLAC test;

- hb-A1C - average blood glucose over last 3 months;

- ALT - proxy for liver fat

- Uric acid - proxy for sugar in the diet

Good luck to all.

P.S. The picture of the salad was taken at 'The Ivy' a restaurant located near the Tower Bridge in London. The base of the salad is watermelon, it was excellent, as was the service.

[Paul12]

I think you can add Calcium Scoring to the other measures. If so then beware as one can have super high PLAC result but ZERO calcium score. If so then you may THINK you're fine (zero CAC) but in fact...you're not.

Also you write:

By lowering your TG, you will automatically lower your LDL-C, but more importantly, you will lower LDL-P (particle number) which is a more relevant CVD risk metric than LDL-C.^

^Source: ncbi.nlm.nih.gov/pmc/articl...

Well I know of someone with LDL-P in excess of 1000 (super super high) and yet Trigs 0.8.

The best thing is simply to do every possible lifestyle change, assume the worst all the time re blood tests etc, but just keep living 'healthily'. That alone will reduce stress.

[sos007 Ambassador in reply to Paul12]

Thanks for your feedfback Paul, for clarity, I did not say that lowering your trigs will put you in the optimal range for LDL-P, I said it will lower your LDL-P. To get it to the optimal level requires very low trigs as well as optimal lifestyle choices including daily exercise, 8 hours of nightly sleep and a way to reduce stress.

For the record, my trigs are 0.43 mmol/l.

The LDL-P measure has ranges for risk - being over 1,000 doesn't put you in the super high range. You must be over 2,000 to be consider very high risk. Anything over 1,600 is considered high.

Some of the links I inserted are broken due to copying and pasting this post from a reply I gave to another person. For some reason the system used for this forum truncates the links when you copy and paste them. I'm trying to reinstate them, but only when I have time.

[sos007 Ambassador in reply to Paul12]

CAC involves using radiation so I generally try and stay away from it.

On the subject of its relevance to risk, it is a mixed bag.

If you are 30 years old with a CAC score of zero, then that really doesn't tell you anything.

If you are 70 years old with a CAC score of zero, that tells you a great deal.

For now I personally stick to blood tests and MRIs (if available) or ultrasounds to avoid invasive testing.

Vitamin K2 is something that has been overlooked for years and contributes to reducing calcium buildup in the arteries. It is found in dark poultry meat and in cheeses from Scandinavian countries, most notably Gouda, and Jarlesberg. The more aged, the better.

You can also buy K2 supplements.

[Paul12]

I see a problem here.

On the one hand studies show that the most effective way to lower PLAC score is....statins, possibly in combination with Omega 3 and Niacin. But statins are the main instrument.

So, statins = good

But what of side effects?

1. Muscle ache could be age or over exercising but maybe not so...

2. Change dosage. Still not working?

3. Change brand

4. Still not working? Are you in anti statins groups? Ahhh - nocebo effect.

Hmmm what we need is clear evidence that statins DO work and statins DON'T work (i.e. costs > benefits)

Evidence statins DO work: PLAC test results. Also LDL particle studies.

OK....

Evidence statins don't work? (Apart from above?)

Well....

Cut that statins cause atherosclerosis.

What???

Depletion of cell membrane cholesterol by statins disrupts caveolae (lipid rafts) and leads to alterations in cell signalling

ncbi.nlm.nih.gov/pmc/articl...

and...

"Thus, the epidemic of heart failure and atherosclerosis that plagues the modern world may paradoxically be aggravated by the pervasive use of statin drugs"

ncbi.nlm.nih.gov/pubmed/256...

BUT, BUT, BUT there's also....

nejm.org/doi/full/10.1056/N...

"In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke"

In my previous post I made a mistake re LDL Particles. The figure was 2455 and Trigs 1.2. The person was very strongly recommended statins at a high dose. Instead he lost weight and exercised more and trigs fell to 0.8 BUT PLAC test is still very high.= at 275 (UK measurements)

It's a problem...

[sos007 Ambassador in reply to Paul12]

The PLAC test measures the stability of plaques. So the referenced individual by reducing their LDL-P and trigs is on the right path, but the stabilization of his plaques through diet and exercise will take time. He can consider statins a temporary solution while he continues on his dietary and lifestyle change; for how long will depend on how long he takes to get to his normal weight for his body frame. In my case I lost 40 lbs over 10 months to get to my natural body weight.

I titrated down on statins over that 10 month period, during my dietary and lifestyle changes and monitored my blood-work every 6 weeks, specifically the lipid panel.

So he must re-evaluate periodically.

As for the pros and cons for statins, I don't think you will find a definitive resolution any time soon as there are too many vested interests.

I don't take them even though my cardiologist encourages me to do so. That tells you what my view is on them. That said, my LDL-P is below 1000 and all of my other bio-markers are also optimal, except for LDL-C which is just in the normal range and not at the ultra-low levels my cardiologist would prefer.

Since I am convinced based on evidence I have read that LDL-P is more important than LDL-C, I will stay off the statins.

[Lillykims in reply to sos007]

Ok I’ll let Kimberley know

[Paul12]

From what I remember, dietary changes to lower LDL-P include....

1. Cut meat and dairy

2. Cut saturated and trans fat

3. Cut sugar

4. Cut refined carbs

5. Increase fibre

6. Raise protein

7. Cut Omega 6 but raise Omega 3

8. Loads more veg

9. Careful with fruit ( glycaemic load)

10. Aged garlic, more garlic, turmeric, ACV, grape seed extract, CQ-10, Saigon cinnamon, Serrapeptase and finally Niacin - take all

11. Macadamia, Brazil, Walnuts

12. More oat bran

13. More psyllium fibre

Plus if course weight loss, body fat loss, exercise, sleep, social interaction

That said, it seems LDL at least can be halved in a few days....

m.youtube.com/watch?v=lYVRK...(Not working as expected?)

[sos007 Ambassador in reply to Paul12]

I eat cheese (usually Gouda, Jarlesberg and Feta) in small amounts on a daily basis. I also use goat milk for my breakfast tea.

I have poultry once per week and red meat once in a while, maybe once every couple of weeks in very small quantities, but always from grass-fed beef. Fish 3 days per week.

I do not consume processed foods.

My sugar intake from all forms may be 1 1/2 teaspoons per day. I don't eat simple/refined carbs at all.

I don't use Omega 6 oils.

My fiber intake is from legumes, vegetables and fruit (usually berries and apples), as well as nuts.

I do not eat any cereals.

I eat 1-2 slices of multigrain or German rye bread with sunflower seeds, daily.

Spices such as garlic and onions are a normal part of a Mediterranean Diet so we use those extensively.

I eat 1/4 cup of a variety of nuts and seeds daily.

I exercise daily - brisk walk for up to one hour. In the gym for weight training 3 days per week. One day per week ice hockey. Summer, 1-2 days per week walk the golf course.

I striving toward 8 hours of nightly sleep, currently at about 7 1/4 hours.

That's how I have done it.