Posted on 08/19/2024 8:34:29 PM PDT by ConservativeMind
The traditional lipid panel may not give the full picture of cholesterol-related heart disease risk for many Americans, according to a study.
There are different types of cholesterol particles that can cause heart disease, including low-density lipoproteins (LDL), very low-density lipoproteins (VLDL), and intermediate-density lipoproteins (IDL). LDL-C is a measure of the weight of cholesterol in LDL particles and is one of the most common tests people use to measure cholesterol risk. Every LDL, VLDL, and IDL particle has a single protein on its surface called apolipoprotein B (apoB).
Prior research has shown that the number of "bad" cholesterol particles, measured by a blood test for apoB, is the most accurate marker for cholesterol risk. However, current guidelines do not recommend testing for apoB in all people.
"Some people have high apoB but a relatively low LDL-C, so their heart disease risk is underestimated by not measuring apoB. Others may have a high LDL-C but a low or normal apoB, and they aren't at risk."
The research team used data from the National Health and Nutrition Examination Survey (NHANES) to assess apoB discordance in the U.S. population. The NHANES database included apoB, LDL-C, high-density lipoprotein cholesterol (HDL-C, or "good" cholesterol), total cholesterol, and triglyceride levels for 12,688 adults measured between 2005 and 2016. To determine the discordance level for each individual, Dr. Navar and her colleagues calculated the difference between observed and expected apoB levels based on LDL-C.
As expected, apoB levels for patients in the study with metabolic risks were higher than predicted values.
"I believe that our results, combined with a lot of other data showing the value of measuring apoB levels, support a revision of the guidelines to recommend apoB testing for everybody, not just those with certain clinical risk factors," Dr. Navar said.
(Excerpt) Read more at medicalxpress.com ...
It’s worth getting tested to sanity check what’s going on, and compensating. I added fiber, mushrooms, and more low carb veggies, and more, to help.
The typical test look great on me. No dr has ever run the B test so I did it myself. And it is high.
I don’t know how hard you have to push to get the B test.
.
I thought triglycerides are worse than LDLs.
Its all so confusing...
As a side note - my LDL has always been good (low), and
my HDL has always been good (high). But triglycerides, not so good.
And doctors have been unable to get them to budge much.
Keep trying different things - they pretty much stay put (high).
So I’ ve quit worrying about it.
But with new test, maybe I’ll have something NEW to worry about.
We’ll see!
My wife is a functional medicine physician and says the ApoB test is a very accurate measure of potential heart disease. In her practice, in addition to medicine and nutraceuticals, they have a nutritionist who helps patients modify their diets. She herself believes exercise is one of the best things you can do to manage the risk … and encourages her patients to stay on an appropriate workout program.
You think that’s confusing?
Wait until you read this....
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684135/
“Apo B and LDL went up quite a bit with a near-Keto diet”
Some argue that was a GOOD thing! I personally think the medical establishment has totally screwed up how we look at cholesterol of all types.
A New LDL-Cholesterol Theory Coming to a Doctor Near You:
https://www.youtube.com/watch?v=MExPhMS2LNU
Another issue: The statistics on population studies involve “How does X affect outcomes for people eating the standard American diet?” But if you don’t eat SAD, then do those outcomes apply? Maybe not.
“Keto Diet and Heart Disease: What New Research Reveals About Cardiac Risk with Dr. Bret Scher”:
https://www.youtube.com/watch?v=r_9S9BYBWo4
Arguably, one needs to look at the big picture. If one has significantly less risk of diabetes and obesity doing X, then X is almost certainly going to help with reducing heart disease, dementia, etc.
I think doctors worrying about both total cholesterol and LDL levels, BY THEMSELVES, are incompetent. I had a doctor try to put me on statins because my total cholesterol was (then) 190 “and that is close to 200, and at 200 EVERYONE needs to go on a statin!”
I told him no. About 10 years later, with 6-7 on low-carb, my total cholesterol is 205 - a 15 point increase due to a 15 point increase in my HDL. The sweet spot for total mortality is 190-260, so if anything mine is a little LOWER than what might be optimum.
We also need to think about WHY something affects our cholesterol. For example, using corn oil will lower cholesterol but INCREASE the odds of dying. A trial looking into it was stopped because the folks taking it were...dying.
Some have found on a carnivore diet that eating Oreo cookies reduces their LDL...so would it be a good idea to add Oreo cookies? Or is it a sign that our thinking about cholesterol & LDL cholesterol is missing the point?
Good article here (with excerpt):
“A Simple Boat Analogy
Imagine a fleet of cargo ships that are constantly being deployed and have two jobs:
Deliver goods, which takes 1 hour
Patrol and help out, which they do for 72 hours
You wouldn’t be surprised to see about 1 in 73 of these cargo ships having cargo and the rest being generally empty at any given time. Maybe some timing on launch or deliveries offsets this slightly so it’s more like 1 in 50 at times, or 1 in 100 other times.
Now let’s change it. What if you’re not seeing just one cargo ship full of cargo, you see 5. What does that mean?
You investigate further and find that there’s a reduced ability of these ships to deliver their cargo. They’re having a hard time completing their first job — the same job that should’ve been easy and take much less time on turnaround.
Maybe there’s a problem with the docks or rockier waters or the boats themselves. Regardless, you see more boats with cargo undelivered seems to associate with bad outcomes so you start to take notice.
Yet conversely, you notice that no matter how many more total boats you have, there seems to be very few bad outcomes when at any given time there are very few that have cargo — suggesting they are making their deliveries properly.
ApoB “Boats” Failing to Deliver
Most ApoB-containing Lipoproteins like chylomicrons and VLDL have a first job: to deliver their fat-based energy (triglycerides) to cells, and in normal circumstances it should happen very quickly (typically less than an hour). Then a large portion of VLDL will ultimately remodel to LDL particles and remain in the bloodstream for 2-4 days.
So let’s recreate our boat job list from above:
Deliver triglycerides, which typically takes less than an hour
Remain in the bloodstream (potentially immune/repair) for 2-4 days
But what do we commonly see in those who are obese, Type 2 Diabetic, or suffering other metabolic derangements?
High fasting VLDL
High fasting Triglycerides
And thus, high overall remnants
I posit the simple explanation in most of these cases is that there is a clearly reduced capability on the part of the existing VLDLs to make their deliveries (job #1), which matches up well with one being past the “personal fat threshold“. There’s little parking left for the triglycerides, so we see an accumulation of fat in tissues that aren’t designed to store it, such as ectopic fat.”
https://cholesterolcode.com/thoughts-regarding-ldl-p-apob-and-remnants/
“The Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate-Restricted Diets”
https://www.mdpi.com/2218-1989/12/5/460
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