LifeCare Chiropractic

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LDL

PREDICTION OF CORONARY HEART DISEASE IN MEN – (12-19-05)

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non-HDL cholesterol High-Density Lipoprotein Cholesterol and Apolipoprotein B in the Prediction of Coronary Heart Disease in Men

ApoB is the protein component of a lipid molecule that carries around the cholesterol. This study compared which was a better marker for coronary heart disease–non HDL cholesterol (the amount of LDL and VLDL cholesterol together) vs ApoB. Elevated ApoB was the best predictor of risk at 4.18 times the risk. Above and beyond “traditional” risk factors.

This is not the first study to come to this conclusion, and yet it’s use is still few and far between in clinical practice.

Read entire article here

JUST CHECKING CHOLESTEROL DOES NOT GIVE A GOOD PICTURE OF HEART DISEASE – (02-21-05)

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Insulin resistance, adiposity influence lipoprotein size, subclass concentrations

This study really demonstrates how behind the research most clinicians are.  Just checking cholesterol really does not give us a good picture of where the patient is as far as their risk for heart disease.

This study evaluated subclasses of LDL (small, intermediate, large), VLDL (very low density lipoprotein) and HDL.  Worsening insulin resistance did not affect LDL levels.  However, strong changes were seen in the subclasses–decrease in the large LDL offset increases in the other sizes of LDL.

So, if one just looks at straight LDL, you just missed the fact that the real picture is one of worsening risk (larger LDL and larger HDL particles are generally considered protective).  Subfractioning of the cholesterol molecules is looking more and more like a good idea…

Read entire article here

RISKS OF CHOLESTEROL IN CORONARY HEART DISEASE – (04-30-07)

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Non–High-Density Lipoprotein and Very-Low-Density Lipoprotein Cholesterol and their Risk Predictive Values in Coronary Heart Disease

Invariably, when I give a presentation to a group in the community, maybe 1 out of 20 know their lipids outside of total cholesterol. The reality is, you absolutely, positively CANNOT appropriately manage elevated lipids without knowing where your HDL, VLDL and triglycerides are. And yet PCP and Internists still look at lipids with blinders on and will aggressively treat patients based on total cholesterol alone.

And yet here, researchers found NO association between elevated LDL and CVD risk. Good thing the only bad thing that happens from statin drug use is fatal rhabdomyolysis.

Read entire article here

WHAT’S THE AVERAGE PRIMARY CARE DOCS GIVE TO CHOLESTEROL PATIENTS? – (03-05-07)

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A Population-Based, Cross-Sectional Comparison of Lipid-Related Indexes for Symptoms of Atherosclerotic Disease

“In conclusion, these observations add to the published data suggesting that LDL cholesterol may not be the best target of lipid-lowering treatment strategies.” Wow. What’s the average primary care doc going to do? We’ve become so blinded to checking LDL and total cholesterol that we haven’t seemed to notice that other markers do a much better job of predicting heart disease then cholesterol.

I can honestly tell you that I’ve had patients come in being aggressively put on statins for a cholesterol level under 230 that would’ve responded to something as simple as a handul of almonds.

Read entire article here

HOW WELL ARE WE MANAGING HEART DISEASE RISK FACTORS?

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Let’s face it.  If you are willing to make changes, managing cardiac risk factors is a piece of cake (or rather…avoiding that piece of cake…).  Lifestyle changes are not difficult, but require commitment.  Society does not easily support healthy lifestyle and requires a shift from what you’ve been doing.  But the payoffs are massive for you and your family.

I continue to contend that lifestyle changes are the ONLY way to manage chronic diseases.  Maybe if we did not live under the false pretense that, because our “numbers” look better (cholesterol, HbA1c, blood pressure, blood glucose, etc…), we’ve dodged the bullet of early death.  I cannot stress enough that this is just not true.  We live in a society dominated by surrogate end markers.  We think that because our cholesterol has magically been lowered by the coveted, mystical statin that we’ve lowered our risk for a heart attack or stroke.  Ok–so maybe you have, but only by a SMIDGEN (which, in medical terminology, is about 1%).  This is NOT prevention, it is false hope.  Lifestyle changes, on the other hand, have true global health benefits that are unquestionable.

This particular study just reinforces how pathetic “we” are when it comes to cardiac risk factors.  We can’t even do it right using drugs!  In shooting for lower LDL levels AND optimal CRP levels (a marker of inflammation) only 12% of the patients in this large study managed to achieve the desired numbers.  You will hopefully note that they were looking at LDL levels and not total cholesterol.  Hopefully, we are finally abandoning the futility of checking total cholesterol in lieu of better markers.

The authors’ suggestions?  “Smoking cessation, weight reduction, and the greater use of more potent statins at higher doses might be able to improve these outcomes.”  We just don’t get it.  It’s almost laughable how sickeningly dependent we have become on medication to “protect” our health.  Even with a society heavily dependent on meds, we still can’t get 88% of the population to target levels.

http://www.sciencedirect.com/science/article/pii/S0002914911004632