It's interesting how in this case The Science ™ is able to take a numeric value and apply a judgment towards the effect of that numeric value without actually knowing the relationship between higher HDL cholesterol and mortality. It's all so 2019.
But let's take this example where The Science ™ is unwilling to examine numeric values, namely Covid. A cursory look at Johns Hopkins Covid Mortality Analysis webpage shows that the inadvertent 'control' nation, Sweden, has done markedly better in every way in terms of managing the disease compared to the US. Their death rate is now 45% lower than ours, all accomplished with almost zero restrictions. But, The Science ™ and their followers are outraged at how their rules were not followed, so these results must be ignored while we watch the US suffer through the fourth wave of the pandemic. No fourth wave in Sweden, though.
More than 1 mil Americans die EVERY year from heart disease. Where is the panic about these cholesterol findings from The Science ™? Where is the outrage? If someone knowingly fails to improve their diet, lower their cholesterol and take their medication, why aren't we forcing them to do this? What about the more deserving followers of The Science ™ who may be denied medical care due to one of these thoughtless people's decision to not follow The Science ™?
Sarcasm of course. The Science ™ followers are frightened of Covid and not heart disease. That's why 1 million deaths per year is no big deal.
4
@KCF Covid is contagious. Heart disease is not.
3
@KCF The Swedish population has significantly lower obesity, greater longevity and generally is healthier than the American population. They also have better access to healthcare. Obesity contributes to Covid 19 mortality rates as does a low vaccination rate. 65.15% of the Swedish population is fully vaccinated vs 58% of Americans.
3
This is pure, unadulterated drug company propaganda. I'm a physician and deal with drug companies and cholesterol management so I speak from experience. Cholesterol lowering medicines lower LDL (bad) and (HDL) good cholesterol. This is a problem if someone has high HDL levels. Initially, drug companies tried to convince physicians to only worry about lowering LDL levels and essentially ignore HDL levels. But the data about HDLs benefits is too strong. The new tact is to convince the public that too high HDL is actually a bad thing. This is gaslighting at it's finest.
15
@MJG *the data are too strong
2
@MJG
You're way behind the curve here. That view is 20 years outdated. We have known for quite some time that the effect of HDL on heart disease is much smaller that that of LDL. Women in particular tend to have higher HDL levels. Lowering them together with LDL into the normal range is not harmful. Just get the LDL down and watch the triglycerides as well. Then all will be fine.
4
The Covid andemic introduced an energetic new slogan into US culture .... "Follow the science."
This three-year old article is a reminder of the old mantra that used to guide things ... "Follow the chatter."
1
As Ivor Benjamin is correctly stating “Having high cholesterol at any age increases that risk significantly,”
What the article is not emphasizing sufficiently, though, is that this risk is cumulative. To best gauge disease risk, LDL cholesterol levels at any age should be continuously added up to generate a life-time account of disease risk. Obviously, that would mean that disease risk can only increase, never decrease, at least not without drastic measures. This is consistent with a model in which it is a lot easier to squeeze the bad cholesterol from the blood into the arterial walls than it is to remove it again through less effective means of reverse cholesterol transport.
We should not be complacent with LDL levels of 100 mg/dl. The "normal" LDL cholesterol level of a vegetarian society living an active agricultural life style without significant consumption of dairy products is ~50 mg/dl. This may not be achievable for everyone living a Western life style, but is should be the goal. And for many people, it is possible, at least with the help of statins.
@Captain Nemo , I had a massive MI 5.5 years ago.....100% blockage of my LAD, 20-hour delay in being admitted to a cath lab.....lots of damage. I have CHF as a result with an EF of ~30. On the day of my heart attack, my total cholesterol was 185, with my LDL being 135. My total cholesterol was always in that range, never exceeding 200. But, I was 5'9", 235 lbs. and sedentary. Thankful to be alive, I immediately changed my diet and lifestyle. I follow the Ornish diet, which is low fat and largely plant-based. I lost 55 lbs. and exercise daily. And, I take 20mg of Atorvastatin (along with an assortment of other drugs for my heart failure). My blood is tested regularly and my total cholesterol now is always in the 80-90 range and my LDL is always in the 50-60 range. Triglycerides typically range between 80 & 120. Just had a nuclear stress test and that came back clear. Knock on wood, I'm largely asymptomatic with my heart failure and CVD seems to be stable. I have a great cardiology team, and I trust them implicitly and statins are on their menu.
@JEG in Raleigh
Total cholesterol 80-90??? With LDL 50-60?
That puts your HDL into the teens.
Are you certain?
If so, is there a history of heart disease in your family and has anyone ever been diagnosed to carry a dominant negative ApoAI mutation?
How about your parents? Any history of heart disease there?
Capt. Nemo, I just double checked my last numbers and they are as follows: LDL: 40, VLDL: 22, HDL: 26, For a total of 88. My triglycerides were 109. My HDL has always been low throughout my life (I’m 66), never going above 40 and usually 30-35, but at least my LDL/HDL ratio is much better than before my MI. There is no history of heart disease in my family. My parents lived into their early 90’s and my grandparents on both sides, into their late 80’s and early 90’s. I’ve been tested for lipoprotein-a and do not have that in excess. I owned a business with 40 employees for 25 years, and that was very stressful for me and certainly contributed to my heart problems. I was fit and healthy in my younger years, and I’m fit now, or at least as fit and as healthy as one can be with heart disease. I wish I had paid attention......I am paying attention now....thankful to be alive.
Heart disease really comes down to two things: genetics and processed foods. If you are blessed with good genetics, yeah! You won the lottery. Either way, eat a mostly plant based diet of vegetables and fruits, lean proteins, and get regular exercise. Remember: you will die. No one wants to hear that, but Americans tend to think we should all make it to 90. Nope. Balance your diet and life as much as possible. Enjoy life when you can. Tough it out when it gets hard.
16
@Joe
And consider taking a statin, if all these measures are not enough to get your LDL to 50 mg/dl.
@Captain Nemo just had blood work taken 90 days after being on 10 mg Lipitor. I’m 64, have psoriatic arthritis so it raises my risk profile and my calcium ct score was 69. For 30 years Cholesterol was always under 200, LDL 90-120, HDL always 60’s to 70’s and triglycerides 50-80.I’m a pescatarian. Cholesterol went to 146, LDL to 64 and triglycerides to 39.
@GW
You had an excellent response to atorvastatin!
Not everyone does. Your starting values match my own almost exactly, as did your response to just 10 mg of atorvastatin.
Good for you! If you were to raise the dose to 20 mg, your LDL cholesterol would likely be 50 mg/dl, i.e. ideal! That is the way I was responding to it. Brings me down to 120 mg/dl total cholesterol.
I pay absolutely no attention to cholesterol. I have a family member who teaches and practices medicine at a top ten med school. She has not prescribed cholesterol meds for patients for years. I will say, however, that coconut oil is a no no. It is more saturated than butter. I shudder at all the "healthy" recipes full of coconut fat. Monosaturated oils like olive oil are healthful, but still 100 calories a tablespoon. I now measure instead of pour. Regardless, at 75 (thin and fit) I am in perfect health still a working professional, gardening, hiking and cycling with a sharp mind. Better to focus on your diet than on your numbers -- stick to an unprocessed plant-based Blue Zones diet, and you may also live a long productive life without resorting to cholesterol drugs that can be harmful. Those bad foods are harming more than your numbers.
12
I read articles that mention tests for people with different scenarios such as the one mentioned here ~
“If a doctor is still uncertain about which patients warrant a drug remedy to lower cholesterol, the new guidelines suggest getting a coronary artery calcium score, obtained via a specialized X-ray scan that measures calcium-containing plaque in the arteries that feed the heart.”
What type of health insurance allows such a test? Health insurance is so prohibitive in helping people to discover their health situation!
9
@Paul This test is shockingly easy to obtain and affordable. I was able to schedule it myself, no doctor's order needed, by simply calling my hospital's radiology department. It is quick and easy and doesn't even require getting undressed. Cost was around $120, no insurance filing. Surely a rarity in today's medical service.
2
@Paul not covered but cost $100. Well worth it.
1
I just scheduled one (before this article came out) and insurance will not cover it unless you have diabetes or some other factors pointing to being on the verge of a heart attack or recently had one.
As others pointed out - the test is usually $100-$120 so you can choose to pay out of pocket for it. Personally I am more interested in the test than taking statins.
Also, my cardiologist told me if you are under 40 it is not recommended as plaque generally has not calcified to the point where it will show up on the test. After 40 you can get it to get a baseline and then periodically after depending on the level of calcium.
I did read somewhere there is some radiation risk since it’s a CT scan but again, I would rather have this test and have a better sense of my risk vs. taking statins based on blood tests alone.
1
so tired of these so called experts.. give it rest would you please.. if you have good levels, then wonderful. and that should be it... period
4
There are a lot of considerations with treatments: Individual endowments for the biological life span; valuation of mortality risks; wasteful mortality reducing risks for aged population; ineffective end of life treatments; negative externalities generated by consumption decisions; assumption that diseases operate independently; detailed data before death; genetically determined parameters of how long each organ system can live; medical interventions directed at preventing death while leaving risk factors unchanged; account for function loss that can be accelerated or slowed by behavior; (e.g. smoking on the lungs).
Estimate dependency in causes of death takes/requires more information than required in mortality data. One cause of death does not permit death from another disease; smoking is not a disease, but it increases the force of mortality for a variety of diseases.
Consider the logic of statistical inference with theoretical limits to life expectancy: New drug launches account for 13 percent of longevity increases and the average annual increase for the entire population is about one week.
The 2D drawing of cholesterol that accompanies the article has an atom too many. The CH3 that overlaps with the blood tube does not exist in the real cholesterol molecule!
12
There is an extensive discussion of the various kinds of cholesterol in Gary Taubes's book "Good Calories, Bad Calories", with far more detail about the research and history of research on this topic than is in Ms. Brody's story. It is not light reading, but NYT readers are up to it. Don't look just at Chapter 9. Take the time to read the whole book.
1
Anecdotal, but all of our personal health is anecdotal: I have high HDL, my mom has high HDL, my grandma has high HDL, my great-grandmother had high HDL, and I don't believe any generations before that were able to be measured. My great-grandmother died in her sleep at 105 years old with no major health problems (other than the normal and gradual degradations of physical condition that you would expect at that age). My grandmother is in her 80s, active and sharp as ever, nary a heart condition in sight. My mom is fit and almost 60 years old, healthy heart, no major health conditions.
My mom and my great-grandmother had the same body type (very little body fat, flat-chested), my grandmother and I have the same body type (curvy and busty), and we have all had different diets and different levels and types of exercise, and all have/had almost the exact same HDL. Let's just say I'm not too worried about my high HDL.
15
@reader and not worrying is probably the healthiest thing any of us can do.
12
As a physician who has worked with Native Alaskan populations, I have to tell you that nobody understands HDL. My patients here, on a traditional salmon heavy diet, have super high HDLs and low LDL, and no heart disease. This changes when they incorporate processed foods into their diet, the numbers reverse and they develop diabetes and heart disease. I consulted a cardiologist about these impossibly high HDLs in healthy patients, and he had no idea. If I had a very high HDL and was otherwise healthy, I would thank my good fortune and be done with it.
25
@Alaska Doctor you are so right... people look to always find something wrong with what is right!! i have high HDL and low LDL, and thats the way it should be...
@Alaska Doctor Those Native Alaskans are sort of the fly in the ointment of our U.S. worship of low-fat high carbohydrate diets. We ought to wonder whether it's their genetics, our dietary disinformation, or both that has something to do with their miraculous escape from heart disease.
@Alaska Doctor
"This changes when they incorporate processed foods into their diet". THE most important message to get from this article and readers' comments.
6
I'm 58.
For the one and only time in my life I let them check my cholosterol at my 50th birthday physical.
It was fine.
Never going to get it checked again.
8
@Larry Thiel
Some people are genetically predisposed. If people get screened at 20 and have cholesterol levels of 300 and above, they still have time to treat the condition. If that same person waits until 50, it probably means a bypass.
@Larry Thiel
I would suggest that you recheck it. It is greatly dependent upon diet and exercise.
Although your genetics won't change, other things do. My LDL cholesterol was 50 mg/dl when I was actively training, running marathons and living on a near vegan diet only. Once my knees were aching too much and I became decadent and gave in to a more Western type diet, my LDL cholesterol shot up to 130 mg/dl.
After revising my diet again, though not drastically, and adding a statin, my LDL cholesterol is down to 50 mg/dl again. And that's where I want to keep it.
We are spending far too much time parsing cholesterol metabolism. I look at cholesterol measurements five times a day. No one has an LDL below 100 without statins. The article's premise is that we can somehow manipulate HDL and LDL ratios through dietary measures and statins. Crazy. You take a statin and you get what you get.
Hypercholesterolemia exists in modern culture because we have an abundance of sugar and refined carbohydrates in our diet, and we eat too much of them. Cardiovascular mortality is driven by the three horsemen of death: hypercholesterolemia, hypertension, and glucose intolerance, the so called metabolic syndrome. And in those patients statins reduce mortality.
In my patient population with low health literacy, cajoling them to exercise and change their diet virtually never works. It's frustrating to care for patients with multiple medical complaints when the central problem is obesity.
30
@A doctor Sorry, not true. Mine are well below 100 and I am not on any statins. Good genes and good diet, I guess.
5
@A doctor
Hi, me too. Just had mine tested and I'm well below 100, no drugs. 62. healthy.
5
Hypercholesterolemia may in some cases be caused by diet and exercise habits, but in all the cases I have had first hand experience with it is genetic and most definitely not controllable by means of diet and exercise alone without medicinal intervention. One would hope that a practicing physician would have enough experience to know that it is a big world with lots of different people in it, and that every medical condition does not correlate with some moral shortcoming.
9
I have an interesting scenario: I have had VERY high HDL all of my life (I'm 64 now) yet my coronary artery calcium score is 0 (perfect). How is that? My cardiologist just shakes his head in disbelief. No one can explain.
8
So is it the risk factors that cause high HDL or is high HDL the risk factor? They have reached some interesting and surprising finding regarding very low LDL achieved through pharmaceuticals.
We need more people working in STEM to find the important answers to these very interesting questions.
1
Thank you for indicating that protein is best in moderation. Unfortunately, the NYTimes print stories from other so-called experts pushing these high protein fads. The reality is that a high protein diet for a sedentary person (and even a person who exercises moderately) is a recipe for kidney problems. Its time for the media and nutritionists to wake up.
5
Any discussion of cholesterol must also include levels of triglycerides which is also carried within lipoprotein particles. It is important to note the Triglyceride/HDL ratio as a better indicator of risk than looking at LDL or HDL in isolation
“ Attia and Dayspring mentioned that the Framingham study indicates that TG/HDL (triglycerides over HDL ratio) is 5 times more predictive of heart attack risk than LDL.”
https://prevmedhealth.com/more-important-than-ldl-the-triglyceride-hdl-ratio/
9
Well said. It would also be helpful to know whether the optimal HDL level varies according to one's LDL level — can a somewhat higher HDL number compensate to some degree for some range of elevated LDLs? But I feel sure that we simply do 't know at this point. More info is always appreciated, but somehow this article is a bit disheartening in that I was unaware there was a downside to high HDL numbers. I feel like I am juggling one too many items now.
2
@Luk Brown
Yes, I understand the tri's are a big factor and mine are great and I'm very thankful because my doctor says this slender person has "drop dead time" LDL cholesterol....but I have refused statins because I had a terrible reaction to red yeast rice supplements and I wouldn't dare take the drugs.
That's been almost twenty years ago and so far my personal treatment plan to not worry about it has worked. ☺️
3
APoB/AP100 ratio is a way better predictor of risk for cardiovascular events, marginalizing HDL and LDL numbers. Read up on those studies and write an article if you dare!
2
Interesting summary, with a misleading header. Cholesterol is a lipid, not a protein. It would be helpful to correct this error.
5
@firthkraft It's a lipoprotein, both lipid and protein. HDL's higher density is caused by the relatively higher amount of protein compared to LDL.
5
@roseberry .....Lipid refers to substance that are hydrophobic meaning that they are not soluble in water. Cholesterol belongs to the sterol family of compounds. Members of the sterol family are rigid compounds that are generally fat soluble (hydrophobic). Proteins are long chains of amino acids. Cholesterol is not even remotely similar to a protein.
This article is nearly three years old. Is there no new research on this topic you can share?
20
Great. I thought I was doing pretty good. I figured my HDL (90) was offsetting a slightly elevated LDL (115). Now I have to worry about lowering my HDL by 20 mg/dl. How about VLDL and triglycerides? Do they matter?
4
@alan Get a fluffy LDL test done. There are two kinds of LDL. I had one done because I eat a keto diet and have similar number, slightly elevated LDL, my ldl is nice and fluffy, no concern over over number needed
From Cooper institute.org
“What you may not know about LDL-cholesterol is that not all LDLs are the same. While some LDLs in our blood are relatively small in size and rather dense (heavy), other LDLs are larger and less dense (fluffy). Doctors and other health professionals often refer to LDL particle size when discussing this issue. Over the past two decades, it has become apparent that LDL particle size plays a very important role in determining the risk of CHD.1,2 As shown below in Figure 1, people with LDLs that are primarily small and dense face a much greater risk of CHD than people with LDLs that are larger and less dense. In other words, two people with the same elevated LDL value might actually be at very different levels of risk!”
3
@Oh My Yes I have read this as well. And that current cholesterol testing methods are hugely out dated. Articles like this one don't add value.
1
Just take the statin ...
"...statin treatment for 6 years was found to reduce death from cardiovascular disease by 24 percent, and overall mortality by 23 percent."
And that "overall mortality" is significant, because these little pills do other magic that isn't well understood but it does reduce mortality by 23 percent.
... you'll live longer.
And those aches and pains, are the just aches and pains you'd have gotten anyways.
1
@David
You should not generalize about those aches and pains. I tried multiple statins and even O-T-C Red Rice Yeast supplements at the exhortation of my physician, all of which appeared to trigger nightly, excruciating muscle cramps. In all cases, I stopped the drug and the cramps abated and eventually stopped.
I believe that for some people, like me, taking a statin is not worth the adverse effects.
9
Another great column. One of the few that counters our de facto criminal health care/pharma system.
Don't get me wrong if your total chol. is over 500 or maybe even 300 you should start to think about a drug.
However our de facto criminal system will push drugs on you anytime they get.
I got a call from my doctor after my blood test came back. First time ever in my life. I though, oh my god, I got cancer, heart disease? He tells me my chol. is high. I said what is it. He says 200. So I said what's the problem. He said well the bad is 120 and we will like to get it lower. The good was ok and the ratio was ok.
I told the nurse who called me, no thanks I don't want to contribute to our de facto criminal health care system where the wealth of the billionaire health execs. are put over the health of the citizen.
22
@Paul
I agree with you 100%. The recommended level of LDL has been set so low, that most people are not meeting it. LDL of 100, 70 - I don’t know anybody who reached that level without taking drugs. My total is 270 and I have so far said no thanks. Above 300 and I will reconsider.
3
@Marie Thank you for your reply. Well thought out. You are not gonna be a victim of these de facto legal crooks.
2
@Marie The levels were set low because the statin pushers influence the heart docs to prescribe the drugs if your levels are above a low artificial number. Good people have known about the statin side effects for years, but most docs do the easy thing rather than focus on diet. However, I will say in the docs' defense that even if they had the office time, it is very difficult to get patients to change their diets. They want pills so there you go. It is incredibly easy to eat a plant-based unprocessed diet, but people just don't want to and last I heard this is a free society: unless you are an anti-vaxxer, but that's another conundrum.
1
I see a lot of comments eschewing using cholesterol as an indicator of heart attacks, and taking statins to lower it based on episodic results ('I'm "x" years old with "y" cholesterol and have never had a cardiac event.'), or specific arguments disputing a study or practice conclusion.
But the bottom line is that there are studies based on millions of outcomes that conclusively and consistently show by numbers that certain cholesterol numbers result in a higher risk of having a cardiac event, yes? The result is you can have your doctor come up with a very accurate percentage risk score of whether you might have a cardiac event in the future. (And, BTW, it takes lifestyle, age, diet, etc. into account.) The decision is then up to you about what you want to do about it. If you are the type of person who believes that statins are more harmful than effective, and that you'll be in the 75% pool when your risk is 25%, I wish you the best. After managing my borderline high cholesterol for years I started taking a statin when my risk started to rise over 15%.
To paraphrase a Rasheed Wallace quote, 'Numbers don't lie.'
What am I missing?
6
@gene99 There are a lot of poorly informed people who feel compelled to share their opinions as though they are bonafide authorities. Got to watch out for those people.
7
Good and bad do not apply to cholesterol. The truth is that LDL cholesterol contains cholesterol in its reduced form, and HDL cholesterol in its oxidized form. The Pfizer disaster drug Torcetrapib taught us the danger of trying to increase HDL cholesterol. It was the worst drug trial failure in history. Many excess deaths. Cholesterol behaves as a powerful anti-oxidant. That is why angina patients can be treated with reduced cholesterol that restores the heart muscle to functioning properly, by ridding its tired cells from metabolized acid-radicles.
5
I have both high LDL and HDL cholesterol. I am a woman in my 60s and have been resisting pressure to take statins for over a decade. Everyone in my mother’s family had high cholesterol and all of them lived into their 80s and 90s. No one in my mother’s family in three generations has had a heart attack and I don’t know what happened before that because they were all in Europe. In my father’s family there has not been a heart attack in two generations.
I am not overweight, I have been exercising – I am a runner – since my 20s, and my cholesterol pattern closely mimics that of my mother‘s family. I do not see why I should take a drug with side effects for a condition that I do not have, namely heart disease. My calcium test shows that I do not have hardened arteries and my stress tests and echo cardiographs have been totally normal. My real danger is atrial fibrillation, particularly since I already have a benign heart arrhythmia, and if I do develop a fib, based on my family history I will take appropriate medication.
There are no cookie-cutter formulas determining who is going to get sick and who isn’t. So long as my tests show that I do not have obstructed arteries and my HDL/LDL pattern continues to followed that of my mother’s family I am not taking statins.
67
While the skepticism expressed in many of the comments is understandable the know-it-all-ism is harder to fathom.
18
Once again, the only reason I love these generally misleading NYT health & wellness articles are to read through the many informed and enlightened comments. I hope the editors and authors read through them and follow-up on some of the excellent citations for future articles. Some comments I may disagree with, but they are all generally well written and attempt to support their view. One last thought: Almost every other commercial I see is for a food product or fast food that, given time, I know is likely to make us systemically and chronically sick. Then every other commercial is for an expensive drug to either quiet our immune system, treat depression, treat diabetes, and treat GERD, etc.. I hope the day comes when more people see the connection and something more significant is done about the failures in both our food supply and healthcare system. They are very much related.
59
There's considerable evidence that higher LDL levels lead to *lower* all-cause mortality in older people, who are precisely those most at risk of dying. Karger recently devoted an entire issue of a prominent journal to this:
Ann Nutr Metab 2015;66(suppl 4):1–116 DOI: 10.1159/000381654 (https://www.karger.com/article/abstract/381654)
An easy-to-read article presenting a few results from Karger's journal is here:
https://medium.com/the-mission/higher-cholesterol-is-associated-with-longer-life-b4090f28d96e
From the article: "High LDL-C is inversely associated with mortality in most people over 60 years."
19
Interesting, despite the headline of this article, and the highlighted best HDL level of 40-60 in this story, the scholarly reference linked here cites the lowest mortality for women at an HDL level of 93, and the lowest mortality for men at an HDL of 73. This story, in fact, isn't what it purports to be - it's not really a story indicating what a healthy level of HDL cholesterol for most people would be, but in fact, one more story about the dominant role of big Pharma in managing disease. The real subject of this story is what level of HDL should be the goal of medical treatment for people who already have cardiovascular disease, which in turn, focuses on a small group of people with inordinately high HDL levels, above 116. For most people, an HDL level above 60 or 70 is still a very good thing, and as I've mentioned, the research supporting this story shows a best HDL for women of 93. This story misleads readers about these basic heart health facts!
64
@JW wrote "This story misleads readers about these basic heart health facts!"
A Jane Brody specialty! The misleading misinformation she spreads is legendary.
The cited study of higher HDL being bestter for women is correct, and interpreting cholesterol panels depends on the *ratios/relationships of all the numbers* (and other variables such as age and gender).
Also eye-opening for readers? Look up world-wide mortality for women based on total cholesterol. Another bell curve. Guess which oldest women are in the sweet spot. That's right - total cholesterol between 200 - 240.
I'll go back to making breakfast now: 3 eggs poached in butter, with a slice of homemade brioche (made with tons of butter and eggs) topped with cream cheese and dotted with frsh raspberries. :)
31
Glad (not!) to hear my HDL is too high. But I already knew this. How about some suggestions for what to do about it? My LDL is 73 and my HDL is 104 and has been over 100 for as long as I have been tested. At 62 I had my calcium score done and it was over 100 - not good either. I eat well, am thin and I run and exercise regularly. I take a low dose statin which does not appear to help lower my HDL at all. My doctor doesn't have any ideas. So do I just wait for a stroke or heart attack? My father died of one at 73.
3
@Shiggy
Try vitamin K2 for the calcium problem. It seems to facilitate the transfer of calcium from blood to bone, a win-win. The supplements are expensive, but natural sources abound. Unfortunately, many contain only a little, and you'd have to eat a lot of them. The richest source by far is natto (fermented soybeans), which I get from a little Asian market near me for only 2.50/4 servings. Personally I find it revolting (smells like sewage, although many consider it quite a delicacy), so I add a teaspoon of it to my smoothie every morning and the 4 servings last about 2 weeks. I noticed that I stopped getting nosebleeds too. Here are some links for your perusal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566462/ and https://kresserinstitute.com/vitamin-k2-consuming-enough/ It is apparently standard breakfast fare among the Japanese (particularly Okinowans, known for their longevity).
7
@Shiggy ... LDL < 60 is associated with plaque regression. Seems reasonable to consider upping your statin dose, restricting your dietary fat intake, or both.
2
Excess of anything is bad, do not hesitate to consult a doctor for any healthcare issue. Online Pharmacy
1
I'd like a complete, reliable list of all the "levels" of everything I need to have and need to fear. What I'll do with the list, is for me to know. Thanks.
8
Having an elevated HDL associated with increased early mortality does not imply a cause and effect. Alcohol has been associated with increased HDL levels. Again, not necessarily a cause and effect. For years my HDL was remarkably elevated. When I decided to stop drinking I was suspicious that my HDL would plummet and that is exactly what occurred. Perhaps high alcohol intake, which raises the HDL is the cause of the negative health issues and not the HDL itself.
16
@Warren D, Precisely. The alcohol consumption can have beneficial effects and adverse effects simultaneously. Eventually the adverse effects will likely outweigh the benefits.
7
@Warren D
Or maybe the HDL drove you to drink. Cause is difficult to discern.
Everyone should have their Lipoprotein (a) checked. It is pronounced" Lipoprotein small a". It is a very sticky, velcro-like lipoprotein. It is genetic so you only need to check it once, if you do not have it. Very often Niacin can lower it. It is often the reason people under 55 have heart attacks eventhough their other Lipid numbers were excellent. Bob Harper, the fitness trainer, is just one example.
11
Upon reading what amounts to another diatribe against doctors, scientific research, and pharmaceutical companies, one is left to wonder how many commenters have read the article or the studies referenced by the article.
Specific mention is made of recommendations to make lifestyle changes to lower cholesterol, using medication as a last resort. This has been standard mainstream medical advice for all the lifestyle diseases for many years. Also mentioned is that there are several other factors which affect cardiovascular health, and that there is still much to be learned about cholesterol. I'm not sure where readers are obtaining impressions to the contrary, but it is not from scientific researchers, medical practitioners, the federal government, or the American Heart Association.
Because vast conspiracies and corrupted organizations make for such good stories, it is important to guard against a tendency to magnify uncertainty, errors and misconduct within scientific research. This tendency is exacerbated by self-styled experts and their loyal followers who seem to take a perverse pleasure in denigrating real professionals. The "You can't prove it" tactic is a favorite one, which has a certain appeal when considering a multi-faceted disease with genetic as well as lifestyle components. In this era of fake news, emotion trumping intellectual rigor, and axing of scientific agencies and budgets, all I can say is: be careful what you wish for. You just might get it.
9
@childofsol
"Mainstream medical advice" gave us gems such as "meat, butter, eggs, and cholesterol are deadly", "eat more heart healthy margarine and soybean oil", and "base your diet on grains/pasta/bread/cereal." The AHA has received funding from margarine and soybean oil manufacturers for decades, and is still today pushing the margarine nonsense.
All of this has turned out to be not just wrong but actively harmful.
But... the solution to bad science is better science. The "lipid hypothesis" has sunk after hitting an iceberg of scientific evidence. Numerous recent meta-analyses have found no effect of saturated fat consumption on heart disease. Controlled trial after controlled trial, with human subjects, finds low(er) carb, high(er) fat diets to be as good or better than your grain orthodoxy for weight loss and metabolic health.
Finally, there is lived experience. Many of us found ourselves fat, sick, and pre-diabetic by following "mainstream medical advice", then gained health and lost weight by ignoring the high carb, grain-based dogma. We won't be going back to your bad advice anytime soon.
27
@childofsol
childofsol, please read my comment to see if that alternative to the “mainstream” analysis in Ms. Brody’s column lacks “intellectual rigor.”
2
@Charlierf
I agree that VLDL is an important consideration, especially as the percentage of these tends to be quite high among individuals with metabolic syndrome or diabetes. There are many people who, if they have lowish LDL concentration, can still have a large number of VLDL particles and be at increased risk. That is not to say however, that LDL cholesterol is not a useful measurement, or that HDL should be ignored either. Many of the arguments are dismissing not just LDL-c, but the entire lipid hypothesis. Without the lipid hypothesis, particle size is meaningless as well. And we should remember that these numbers are quite highly correlated, at least among the population that is still relatively healthy. Lastly, you and I are likely getting this information from the same sources, and it is not from internet health gurus proclaiming that the system is corrupt and only they know the score. No, the information is available thanks to the very same systems, organizations, funding sources, methods, and even many of the same individuals denigrated as being corrupted, obsolete, or what have you. Lastly, there will be a variety of measurements and courses of action taken in a clinical setting which depend on the individual patient, ease and expense of testing, etc. There is almost always a cost-benefit analysis or a harm-benefit analysis to be made with respect to population screening, whether we're talking about routine mammograms or various blood tests.
2
It's quite clear that doctors don't understand cholesterol. Until they can prove to me they do, I have decided to decline their kind offer of counting it for me.
10
There is a test called NMR LipoProfle that calculates cardiac risk based on lipoprotein particle size and number. It was developed by Dr. Ronald Krauss:
https://www.virtahealth.com/about/krauss
You can order it yourself online. I've done it. It's a little over $100. Or maybe you can get your doctor to prescribe it and get your insurance to pay.
4
We had better discuss what is 'atherosclerosis' nowadays instead of cholesterol, LDL or HDL discussion which originated by pharmaceutical sponsored researchers amplified by authoritative organizations like American Heart Association.
"Atherosclerosis is a multifactorial, highly complex, chronic inflammatory disease. While it has numerous causes, it typically begins with endothelial (lining of blood vessels) dysfunction triggered by one or more of the traditional risk factors, such as:
Smoking
Hyperglycemia (high blood sugar)
Hyperlipidemia (high levels of lipids such as fats, cholesterol, and triglycerides)
Diabetes
Hypoglycemia (low blood sugar)
High stress levels
Hypertension (high blood pressure)
Obesity
Circulating immune complexes
(This summary was made by Dr. Jill Carnahan, a functional medicine doctor)
She explains furthermore details with references of lots of medical researches. (Please Google her newsletter titled, "Could This Bacteria Increase Your Risk for Heart Disease?"
She warns of "The possible association between C. pneumoniae and atherosclerosis". C. pneumoniae infections have also shown to elevate levels of circulating inflammatory markers, such as interleukin-6 (IL-6) and high-sensitivity c-reactive protein (hsCRP).
2
@Wind Surfer
Plus - heredity factor, hypercholesterolima / liver produces too much cholesterol. Diet, exercise and medication can control this but many people with this condition have CAD .
The LDL/HDL 100 and 55 are often unattainable by many even those on the highest dose of the most powerful statin drug- rosuvastatin calcium aka Crestor.
After that the newest injection drugs .
Once again this writer does readers a great disservice with incomplete information-
First high density lipoprotein (HDL) cholesterol good. Now HDL bad.
As a person who works with numbers all the time, I am always perplexed by physicians and health care professionals confusing correlation with causality.
High cholesterol has been shown to be correlated with higher risk of heart disease. Some people who have heart disease have high HDL. or Some people who have high HDL have heart disease. not same, right? but same correlation.
The problem with these studies that most of the researchers don't talk about is the complexity of factors, known and unknown, that cause heart disease. From genetic makeup to exposure to infection during childhood, type of nutrition (and levels of it), physical activity, family and social interactions, there are so many confounding factors especially that can affect one's heart that it is particularly futile to look for a correlation between high HDL and heart problems especially when the sample size is so small to begin with.
I am one of them. My HDL went from 34 to 110 mg in 2 years because of the change in lifestyle... 5 mile walk every morning. Rowing. More vegetables. Less alcohol. Regular sleep. And because I did this, my risk went UP for heart disease. Gee thanks.
All I can say is, stop worrying and start living.
37
Wow- are we still blaming ancient foods (read animal products) for modern diseases? The grain lobby has done a number on us all. According to Plato grains are for slaves. Vegetables are not all they are cracked-up to be, either. (Read oxalates, lectins, and goitrogens-not to mention the bio-UN-availability of the nutrients in veg).
Got IBS? Thyroid problems? Hella gas?
Get Meat.
8
@MaryTheresa
The grain lobby? Livestock are fed on grain and soy.
There have been no industry groups who has exerted more influence over U.S. dietary guidelines than the meat and dairy industries.
Processed foods manufacturers have also had influence, which probably explains the lack of a 100% whole grain recommendation in the dietary guidelines.
Contrary to popular opinion, whole grains are not unhealthful, any more than vegetables, fruit, or legumes are unhealthful. These are all "ancient foods", and what most of our ancestors have been primarily subsisting on for many years. The fact is, as diets become Westernized, consumption of whole grains and starchy vegetables declines, and these calories are replaced with fat calories, and secondarily, sugar calories.
8
@childofsol
"There have been no industry groups who has exerted more influence over U.S. dietary guidelines than the meat and dairy industries."
Then the meat and dairy industries should ask for their money back, because _every round_ of dietary guidelines since 1980 has recommended less meat, fat, butter, etc, while calling for more consumption of corn, soy, and wheat products.
Meat, fish, and eggs are a heckuva lot more "ancient", by millions of years, than grains and legumes. As diets becomes Westernized, traditional foods are replaced by refined grains and refined seed oils, not by animal fats. Your alternative vegan facts won't save you, but perhaps can get you a job in a certain sinking ship administration.
4
@childofsol. Modern vegetables, fruit, legumes and grains are not ancient foods. About 99% of these foods found in the supermarket are very significantly larger, sweeter and much more plentiful year round than their wild counterparts. For example, wild strawberries are the size of a pea and very seasonal; and ear of wild maize (known as corn in US) was about 1 inch in size, wild celery was about the size of a blade of grass and so on. Before agriculture plant sources of food were scarce, very fibrous, bitter and unappealing for human consumption; however eaten for survival if hunting was insuficient to provide the preferred nutrition.
7
Statins are bad. They also give sedentary people with bad diets a false sense of well-being. I have friends who take as many as 40 mg per day so they can be below 150 on the total cholesterol scale. This is madness and brings into focus the relationship between doctors and pharmaceutical companies.
23
@Ricardo de la O Thank you! And they may be exacerbating the Alzheimer's epidemic by reducing cholesterol that is essential to the body and especially the brain.
6
There is a better correlation between the small-dense LDL fraction of LDL in peripheral artery disease than with total LDL so it seems likely that a person could have a higher LDL number but the profile of LDL particle size and density might make the news better if that could be determined, but were stuck with this relatively cheap test. Personally, I think you need to have more going against you than merely moderately high LDL to warrant a drug. Like say also high triglycerides or blood pressure or low HDL, general lack of fitness, bad diet. You need to look at the whole patient because the blood panel isn't reliable and high enough resolution by itself. If you seem healthy, it might be possible that you are and then the statin might do more harm than good.
9
After reading the column and the comments I wonder whether my horoscope might be more predictive of my heart health than HDL/LDL.
28
@s parson
Wise response.
There's so much murkiness around HDL/LDL levels because there's a medicine for that, and it's worth many billions of dollars.
Decades of research, but no clear chain of causation that explains how lipids cause, or don't cause heart disease.
Many, many pharma sponsored studies of statins, but the NYT still runs a column asking if statin-caused myalgia isn't all in our heads.
I'm with you--astrology has as much chance of being informative as another lipid panel in my medical records, or more statin in my meds collection.
8
The ratio of HDL to LDL has been shown to be the best predictor of heart events in lots of research, dating back many years. Either one by itself isn't that meaningful (although very high LDL is usually not a good thing). Research-based cardiologists, weigh in.
3
Wouldn’t it stand to reason that higher HDL might actually counter higher LDL? Both of my scores ar very high due to familial/genetics, but my calcium scoring test was at zero, the best scoreyou can have. I think that the experts still have much to learn.
8
@David
Completely agree with you. I have LDL of about 160 and HDL of 95. Two independent doctors strongly recommended statins. I balked, and the doctors assured me that I would have blockage. So I took the calcium score test, reflecting the calcium score of -0- at age 53.
These drugs are over prescribed and my doctors shrugged at my resistance and then also stuck to their recommendation in the face of compelling evidence that no blockage exists.
21
I don't think the machine was plugged in.
1
'Current recommendations call for LDL cholesterol levels to be under 100 milligrams per deciliter of blood serum for people who are otherwise healthy, and under 70 milligrams for those who already have heart disease or are at high risk of developing it."
For people who have whatever complex factors make them more likely to have a heart attack e.g. those who've already had one, these low targets make sense. For the general population there is no persuasive evidence that these recommendations contribute to better health. It continues to amaze me that the majority of Cardiologists cannot read their own data accurately and are so enthusiastically continuing to pump their patients full of pills in spite of the evidence that they in fact do more harm than good. Better to prescribe a medically supervised weight loss and exercise program -- ah but that would be sooooo hard.
16
It is well known that a high intake of alcohol over a period of time will very significantly raise HDL in the blood. Therefore logic would say that there are good reasons for high HDL and bad reasons for high HDL. Population wide studies will just lump everybody together including those with beneficial high HDL with the alcoholics.
5
@Luk Brown
I work with a lot of alcoholics and have yet to see one with normal HDL. They are all way way below.
2
@Steel, Alcohol Consumption Raises HDL Levels -
https://www.ahajournals.org/doi/abs/10.1161/01.cir.102.19.2347
@Luk Brown I read it and it was dated 2000. I appreciate you sharing and will try to find more recent study. I have high HDL
1
Part of the reason it's challenging to sort out the risks of LDL and HDL levels is that there is another lipoprotein called lipoprotein "little a"- Lp(a)- that also plays a very important role. The levels of Lp(a) are inherited and vary greatly between individuals. High levels put individuals at significantly higher risk of cardiovascular disease. Laboratory tests exist for Lp(a) but, to my knowledge, there isn't a commercially available test. Furthermore, to my knowledge, there are no medicines available that can help lower the levels of Lp(a). Many physicians may not even be aware of this independent risk factor.
2
@Karen Indeed...I'm 54 a former athlete, my blood work is considered the model of a healthy person except my father died when I was 4 of sudden cardiac death. My cardiologist tested for lp-a and sure enough very elevated...then my CT calcium score was very high. I'm now on a statin with some diet modifications (though mine was good to begin with). A repeat CT will hopefully show some improvement.
Am I worried? A little. I am a SICU nurse who works nights in a very busy level 1 trauma so I have a higher than normal stress work environment. Ahh, so much to do, so little time.
6
@Karen
If one decides to test for Lp(a), the test only needs to be done one time, if I'm not mistaken. I just had this test done myself, so does that mean it IS commercially available? My doctor did not order it when I requested him to please do so, so I just had it done on my own, and paid for it.
1
@Steel
Indeed, a google search revealed that it is now commercially available. Thanks for pointing that out! It is still not generally screened for or discussed by physicians because an individual's level is genetically determined and there is little that can be done to lower Lp(a) levels. The main reason to repeat the test would be to confirm the first result but it's not something that one should need to repeat frequently.
Before the Affordable Care Act, individuals could be denied coverage for preexisting conditions. A high level of Lp(a) *could* be considered a preexisting condition by an insurer. Therefore, before the ACA, an individual may have wanted to carefully consider having an Lp(a) level entered into their medical record, especially given the current treatment landscape.
3
several misconceptions;
1. while bless Ms Brody for daily exercise, the idea that it helps with reducing high HDL is just wrong despite its other myriad benefits. HDL is extremely difficult to measurably change. Any Dr would would give a drug based on high HDL alone is a pill head and should have his pad confiscated. but;
2. of people with high HDL >90% also have high LDL. but aggressive drug therapy to maximally reduce LDL is btw questionable and counterproductive due to side-effects of statins of which there are many esp reduced energy levels, muscle/joint issues and sexual issues for some men.
so I propose that rather than arguing various drug methods with small marginal differences we should consider;
1. doing whatever it takes to reduce total body weight by 5% and better 10%. we can argue low carb vs low fat blah blah blah but this ONE single change will reduce even eliminate the need for statins in I believe more than 50% of people. it also produces big changes in blood pressure, inflammatory response and the biggest one; insulin sensitivity.
2. getting min120 minutes/week of movement, for many nothing more stressful than walking.
I'd love to see a large clinical test to see exact % of people who no longer drugs with weight loss alone. the 50% is just my own opinion. problem is the drug companies want you to believe its 0%. and to really drive em absolutely nuts add in measures to reduce inflammation and insulin sensitivity. nah too revelatory.
4
One thing I do know is that Big Pharma is interested in selling more pills so they may make more in profits. Bad medicine any way it is looked at. How about a cure for diseases that kill. Wait, there is not a sustained profit by getting rid of disease. Keep the human population sick enough to take Big Pharma's medicine for many years. Disgusting! So too are our elected officials who take money from Big Pharma!
14
I get so tired and annoyed when Drs only look at LDL and not what I report ,who as an elderly man can run up 5 flights of stairs (88 steps) while carrying my wife's 30 lb transporter chair after doing so ,I am not winded and hardly breathing differently then when at rest ,that is my personal cardiac fitness stress test , I also don't need to get up and pee at night ,that is my urology test, I can pick my wife up in a jiffy (she is 135lbs} when she has a fall several times a day related to advanced Parkinson's disease,that is my Physical therapy.
Speaking to my young Internist ,she would wish for me to be on
4 different drugs just looking at me as a blood test paper .
My testing:
HDl normal LDL 136 I am over 80 years of age and in my own self evaluation I can live as proven here with 136 and that's that !!!
58
@Carlyle T.
As a Cardiologist in the very city you call home I agree with everything you said.
14
@Carlyle T.- I'm with you 100%. Doctors should not just treat numbers on tests but look at the whole picture of the person.
5
@NY Doc
Thank you, if it helps to mention that my own interventionist Cardiologist might agree with you as he knows and takes into consideration my busy lifestyle the amazing strength I still have and energy needed as a caregiver to a very ill mate ,it's the primary Doctor that I was assigned after my own Internist of 22 years retired ,that looks at me as if I am crazy not desiring a statin or Repatha.
9
cholesterol is not a protein, so whatever is in the article would be discounted in meaning since the title is technically incorrect.
3
@Jerry LDL and HDL are proteins, technically lipoproteins, that transport cholesterol. So nothing was incorrect.
5
If your body did not need LDLs, it would not produce them. They are not the actual culprit. When arteries become irritated, the body deposits LDLs as a plaque to contain the irritation. Focusing on lowering them is like treating a symptom instead of the disease.
I would suggest American medicine emulate much of Europe and routinely check for c-reactive protein that indicates artery irritation rather than an almost insane focus on cholesterol.
34
@Tom Rowe But... if we don't focus on cholesterol, how will people get to look down upon others for their apparently poor lifestyle choices, and then laud themselves loudly in comments sections for how low their own cholesterol is, obviously due to their [insert here] diet? Surely there must be SOME earthly punishment for those shameless hedonists who permit themselves to enjoy butter!
I had a balloon angioplasty with three stents in a major coronary artery ion 5/31/1996. Since then I was on aggressive statin therapy for all these years. My cardiologist was "drinking the Kool Aid as he put it, and I started drinking it right along with him.
In the intervening years up to the present I have done a Stress thallium test every other year since 1996. In all runs on the treadmill I was in the top 10% of my cohort for jogging. My radiologic pictures revealed no significant re-occlusion of coronary arteries. I took this test on schedule when I moved to Florida for retirement as well.
In these 22 years all my test were negative for new blockages. However in March of 2017 I experienced a re occurrence of early morning angina for the first time in 22 years. I had had no cardiac symptoms in these years. My cardiologist had me do a pet scan after my verbal report of angina symptoms. The test came back negative with some possible minor obstruction possibly detected... However on March 23, 2017 when I was undergoing what we all expected was an angioplasty and possible need of a new stent. Instead the catheter saw all coronary arteries were blocked at 75% or more. I had CABG, quintuple by pass two days later. My point is that Statins did not prevent re occlusion, cholesterol numbers were of no practical value whatsoever. Nor were the stress thallium or Pet scans of any use. Cardiology is in crisis.
51
@IntheFray Unfortunately, nutritional science (is that a thing?) also seems in crisis. We don't even know what is heart-healthy to eat anymore! The Keto/Paleo folks are gobbling down fats and losing weight, thus doing something to something or other in their bodies. Most of us are eating an "everything in moderation" version of non-buttery, non-dairy, low red-meats. As for exercise, running is out but walking is...I don't know anymore. Are we being encouraged to walk? Is that okay? Should I discontinue my statins now that the numbers are "good," as my doctor wrote? And if you had it to do over again, knowing what you now know, would you have started down that invasive path?
5
@IntheFray
In the 1950s, your expected lifespan after developing unstable angina or having a heart attack would have been less than two years. Stents and statins bought you an extra twenty years of pain-free, healthy life. If I were you, I'd be happy to keep taking those statins.
12
Actually they worked very well. They changed your biology for a long time and you presented decades later with stable disease rather than with an acute and massive heart attack or dead.
7
Reading the referenced article, I found the lowest mortality points were at HDL levels of 73 mg/dL for men and 93 mg/dL for women. The statistically significant increase in mortality risk was noted from 97 mg/dL for men and from 116mg/dL for women. This is not exactly what NYT article concludes or I missed something.
29
@Adam
Thanks Adam a significant difference from what the article says.
8
@Adam
Thanks for reading the data. I am a female and have HDL at 87 mg/dL and was feeling pretty good about things until I read this article. I'm feeling a little better after reading your comment.
Why on earth would they say the "sweet spot" is 60-70 mg.dL?
9
@Barb Probably because it's always about the men. The fact that women can be equally as healthy while both a little fatter than men and with higher cholesterol than men just isn't something that our puritanical society is willing to accept, I guess.
1
Focusing just on cholesterol numbers is bad medicine. Cholesterol is needed by the body to manufacture vitamin D and hormones like pregnelone, dhea, estrogen, and progesterone. Elevated cholesterol levels could mean your body is under stress as excess cortisol levels raise cholesterol levels. Endocrine disorders like hypothyroidism elevate cholesterol levels too as does kidney disorders and disease. Instead of writing a script for a statin, doctors should be searching for the cause of elevated cholesterol through further testing.
50
Unfortunately that’s a time consuming tasks. Most doctors give a pill to treat the symptom and then run to the next room to do the same with the next patient.
7
I just had a full blood panel done, all healthy, yea. My doctor is employed by one of the premier hospitals in the country, he’s very good about being up to date on the latest testing guidelines, and for LDL, they say less than 130mg is normal. Does Big Pharma want everyone below 100mg? Or is 100 some medically magic number?
7
@Carol M My take is that Big Pharma want everyone on as many lifelong drugs as possible. Let's not get started on those hyped happiness drugs...
13
Before you begin drug(s) for cholesterol, get the full range of tests on your heart, especially a radionuclide test, which takes 3D picture/video of your heart at rest and under stress. It takes a host of measurements including amount of plague in arteries on the heart, pumping volume and efficiency of the heart (showing leaks, etc.), and quality of the muscle itself.
I say this because I've had high HDL, LDL and total cholesterol for at least 2 decades but there are no signs (plaque) of it on or in heart. My heart has no problems at all. I've had a minor blockage of my pulmonary artery for 30+ years and my body has developed alternative arteries to adapt to it.
After trying statin drugs and red yeast rice, which had (commonly known) severe side effects on me, my cardiologist said don't worry unless the annual tests show the cholesterol has changed dramatically.
10
Definitely do not get a radionuclide test unless it is clearly indicated based on symptoms. These are not for asymptomatic people except under very specific circumstances.
11
I suggest reading the works of Fred Kummerow. He lived to age 102 The cholesterol has to be oxidized to harm you.
2
Whatever the perceived problem, meds are not the answer.
6
@Chuck Burton If you already have heart disease "meds" can save your life.
6
More fat for the fire. I have a family history of heart disease and high BP, and I have a history of both. For the past 15 years I have had HDL readings of 95-100 and prior to going on statins after my triple by-pass surgery four years ago my LDL was in the 100-115 range. My overall ratio was generally 2-1 or less. Also, my C-Reactive Protein and Triglyceride numbers were very good. I should add that for almost 30 years I was a competitive runner in excellent shape (maybe the cause for the high HDL). In any case my arteries clogged and at age 67 I had the by-pass. I had assumed the high HDL and exercise would be enough to offset my high LDL numbers and genetic propensity for the disease. I was wrong. So maybe my HDL has been too much of a good thing but I think the high LDL (and genes) would have been the time bomb no matter what. Since my operation I have been on 80 mg.a day of Atorvastain and my Cholesterol numbers have been around 95-100 HDL and 50-59 LDL, and I watch my diet and continue to exercise every day. But now I have to ponder the high HDL. My cardiologist thinks not.
3
Less is more. Less medication, less testing (always question necessity of tests), and live a more healthy lifestyle.
9
Don't sleep in the Subway Darling,
Don't stand in the pouring rain...
2
Ms. Brody credits her physical activity with her HDL levels. In fact, HDL levels are more associated with good genes, not lifestyle changes. As remarked by @Judith, the article tells us little about how HDL levels can be changed. I have a low HDL, exercise frequently and take a daily statin but my levels of HDL don't change by more than 10% when I am tested. Anyway, I am 76 and so far have no heart disease.
13
Most people I know put minimal effort into lifestyle changes. For lifestyle changes to work you must make permanent changes. Sure big pharma wants to sell you prescriptions, but most of the time it is the patient that is not willing to do the work consistently.
13
On keto diet for almost two years. My HDL is 147 and LDL at 100. On the chart the LDL might look high. Ask for fluffy LDL test.
Determined no risk because fluffy LDL good. And triglycerides are a super important part of the picture. You should be concerned about all three!
Ask your doctor for the “fluffy” tests. My doctor did not know about them.
8
@Mary For those who are interested, Mary is referring to the nuclear magnetic resonance blood test (NMR Lipo Profile). It looks at the size of cholesterol particles. If you have a high LDL, but your cholesterol particles are big (i.e., "fluffy"), that's good. If your LDL cholesterol particles are small, then that's not so good.
9
Of course it must be bad. Anything outside of arbitrarily selected "normal" must be a danger and must be treated by the medical establishment. A new drug, ongoing testing, treatments for the side effects of the treatment. They have simply realized there is money to be made from those darn healthy people.
23
This article seems to have misquoted the HDL study in a misleading way, especially for women. In fact — and facts matter — “this study showed that there was a nadir in mortality rates among European Caucasians at HDL-C levels of 73 mg/dL for men and 93 mg/dL for women. All-cause mortality rates increased significantly for men with HDL-C levels above 97 mg/dL and for women above 135 mg/dL.”
These “good” numbers are much higher than those quoted by Ms. Brody. More accuracy would be very helpful in the future.
59
@Kim Thank you for this - I will now go do more research. I have always had high HDL and my doctors regularly pat me on the back. Now, I read here that my high numbers are possibly a risk. Off to find some actual study results, for women specifically.
More confusion from the medical profession.
11
@Dan Green
What's horrifying is the inclusion of children as young as 2 into this pharma fantasy.
31
HDL and LDL aren't even cholesterol - they're proteins. Stop this hamster wheel of "this is good, no that's good, no that's good, no that's bad, no that's good". Read Grain Brain, understand this stuff and move on to a healthier you. Lose weight, understand the true risks for heart and brain disease, reverse type 2 diabetes (I know people who were diagnosed with type 2 diabetes who now have medical certificates stating they no longer have it). Change your life. My triglycerides dropped 100 points in 6 months.
Grain Brain by Dr. David Perlmutter. You're welcome.
15
@Mike
YES, well said! Excellent book.
2
@Duggy Yes, Grain Brain is a must read. Dr. Perlmutter is an exceptional individual and medical professional. I look forward to re-reading the revised 5 year version that was just released.
1
The first thing that concerns about cholesterol tests is that 250 used to be the mark for high cholesterol, when Big Pharma came up with all these medications they actually made the major health organizations that set the standard for medical tests drop the number to 200. I always come in over 200 mark when tested and of course the meds are always pushed on me, considering the major side of effect of statins, you couldn't pay me to ever take them. I've noticed these past few years my Dr. does the ratio of HdL/LDL/Triglycerides and says she's not "too" worried about my readings, I always mention the side effects of statins, diabetes being one of them for women and that always shuts them up (for a while).
37
@ShirleyW
One of the principle side effects is heart failure from diminished CoQ10, which is ironic.
8
I'm pretty sure that reputable other sources question the value of the calcium scan of the heart. What's the data to support efficacy? When you see companies advertising their mobile vans to do these kinds of tests, you start to wonder if it's more a money-making proposition. And then complaints arise about people "overusing" medical care.
But seriously, if I tried to keep up with all the recommendations emanating from Brodie's columns I'd have no money and barely time to sleep. It's exhausting.
7
@Anne Hajduk
Actually these scans don't lie, they give you a picture (high speed x-ray) of calcium build up in your coronary arteries. A scan is about $100, and can do far better than the Framingham protocol or cholesterol tests to give you the real goods on your heart.
4
Well this is disturbing. My HDL is over 100. But then all my LDL is light fluffy kind. And no risk or history of heart issues in my family.
1
@Susan: (This is Mrs. Gary) Same here. Dad lived to 93 with no heart trouble, high HDL all his life, and I have his build.
2
Does everyone who reads the " health " articles printed by the NYT and other national publications understand the concept of" population medicine?" The billions devoted to medical research have one goal: to reduce the cost of national health care by attempting to determine which therapies may produce a noticeable decline in a given disease in very large " populations " of people. The studies have nothing to do, dear reader, with you as an individual, but hope to have an effect on a huge cohort of people of which you, if you fit the definition of that cohort, happen to be a part. When I read comments, I have the impression readers hope to glean information relative to their personal situation and often assert that their personal situation confirms or contradicts the studies. Assuming a study is accurate, the guidelines assert only that of , let's say, 100 million people who take whatever drug is recommended, a smaller group will become ill in the test group that took the therapy than in the group which did not......let's say, a 20% reduction. That means that out of the 100 million people who took the drug, 80% will not receive any benefit. No one knows in which group they will be as everyone takes the drug: assuming you will be in the lucky 20% is just that, a hopeful assumption. But, from the point of view of national health policy and "population medicine," money has been saved and the system made more cost effective, efficient and, yes, beneficial.
24
@Don Pablo. 4 or 5 percent is considered statistically significant and that’s good enough in most cases.
3
@Don Pablo
Statins show a benefit of one per cent.
3
Nope.
Depends on the baseline risk.
1
This article seems unnecessarily alarming to those of us with relatively high (and healthy) HDL-C levels. The HDL-C levels associated with adversity in the actual research were more than 97 mg/dL for men and above 135 mg/dL for women.
9
Thanks for this - I’ll read the research. A doctor years ago told me my HDL was the highest he’d seen In 30 years of practice (consistently 120-125 with healthy LDL) - and that I could eat as many eggs as I wanted every day. Which was great news to me! So admittedly this article was a serious buzz kill. I have a physical coming up so reliable and accurate info will be golden when I check in about my egg consumption — and all else — with my physician.
2
This article didn’t mention that there are two kinds of HDL, large and small particles. The large is better as it doesn’t enter the arteries. It is still better to have a higher HDL. Have your doctor test for HDL composition.
5
From the article " Experts have also learned that in most cases, it is not necessary for cholesterol tests to be done only after an overnight fast, which should be a relief for both patients and their doctors". The differences between fasting and non-fasting LDL and HDL levels in MOST people are indeed small enough such that it doesn't matter for SCREENING. But if you are about to embark on drug treatment of LDL and HDL based upon just barely meeting whatever criteria are being used, as a physician I would recommend following up with fasting levels. This because for some people the differences between fasting and non-fasting levels are not so very small. And the move to drug treatment is likely to be for the rest of your life. So you want to be sure before making that particular commitment.
22
@don
I'm sitting on a script for my annual blood test. Actually, this is my second script. The first expired. This new one is in its second week. Sorry, but it just takes me forever to be able to go 8+ hrs without eating or drinking. Part of that reason is my timing is off as I work nights, sleep days. I wish there was a better way.
4
@Ron A You probably have urgent care or a hospital-based lab near you. They are open at odd hours during the day and night and you might be able to find one with a schedule that suits you.
You don't eat when you sleep, so plan on going when you wake up. If you sleep 8 hours, you've got it, get up, do your standard wakeup routine, and get over there. Tell them how long you've been fasting, most places will make sure you don't wait too long, they don't want you passing out. Bring orange juice or an apple for a quick recovery.
6
Finally, I have figured out a mnemonic to remember which cholesterol is which: HDL, high good, LDL, low good. Now I can start worrying. Oh, wait, never mind.
10
For the past 35 years, my physicians have warned me about my "high cholesterol." I have read all kinds of research about total cholesterol, total-to-HDL ratios, buoyant vs. dense LDL, HDL-triglyceride ratios, and on and on. I go out for a 2- to 3-mile run every morning, don't smoke, don't behave like a glutton, and I am still here. In fact, I have been here so long with "high cholesterol" that a growing number of my contemporaries are dying of cancer. I am now in the demographic where death is not a shock; rather, the early adopters are adopting. I see no reason to alter a healthy lifestyle while the medical-industrial complex comes out with a new theory every 3 years. Meh.
208
@Greg Goth. You and my husband are just alike and I applaud you both. He is 73 and perfectly healthy with "high" cholesterol. All of his friends are pilled-up for one thing or another and always ill. I wish you both a continued healthy life.
32
At 42, was inches from death from a 98% occluded anterior descending artery. I had a dismal family history with both paternal grandfather and father having heart attacks at age 42. I was thin, in good shape, but LDLs were 177. Following an atherectomy, which saved my life, I went on an extremely strict diet but cholesterol numbers barely moved. At 42 I had great hesitation about starting statins. I’m now 69, and am convinced that statins saved my life.
Total cholesterol has consistently been around 160, LDLs below 70, and HDLs in the 50-60 range. Where would I be without statins? I assume in a cemetery.
They may not be for everyone, but I am so happy to be alive.
71
@Drmallard
If you haven't stopped eating red meat I'd strongly advise that you do so. Some of the newest research on nutrition and heart disease were focused on compounds in red meat (both beef and pork) that cause arterial plaques to form. Harvard School of Public Health published a large and very long term study which showed a statistically significant correlation between red meat consumption and ischemic heart disease. The World Health Organization even has unprocessed red meat categorized as a carcinogen.
I personally don't believe any of the medical establishment's theories of heart disease and cholesterol. I've always had high cholesterol (its usually about 300) but have never had any signs of heart disease at 68 yrs old. But, I also haven't eaten red meat since my early 20's and only occasionally eat fowl and fish.
I've suspected for many years that the American red meat-heavy diet was part of the cause of the high rate of heart disease in the USA. I also suspected that hydrogenated fats were a strong cause of heart disease and I'm happy that trans fats have now been banned (which may be one of the causes of the dramatic reduction in heart disease mortality in the US and similar wealthy developed nations in the last several decades). Despite that reduction the US is still #1 in heart disease related deaths compared to similar countries.
We all need to eat the kind of food our great grandparents ate. Real. Healthy. Food.
1
@CarolC Some of our grandparents ate quite a lot of red meat. On my mother's side, the grandparents raised their own pork and ate it frequently. They probably did not eat much beef because of the cost. There were a lot of biscuits and gravy, but home-grown vegetables and fruit, as well. The grandfather died of heart disease at 67; the grandmother lived to 94 in good physical health but with dementia for the last 4-5 years. My mother is still here at 96, in good physical health but with dementia. Go figure.
2
What were your HDL and Triglyceride numbers like? ApoB?
Actually the best advice my mom gave me was avoid head-on collisions with Mack Trucks....
40
@Paul
Best advice my Dad gave me was, avoid( Bone Crackers), ( Doctors )
3
@Dan Green
Best advice my Dad gave me, AVOID PRIESTS AND DOCTORS!!!
7
Momma was right!
1
There are strong headwinds working against sensible advise to get check-ups, eat a healthy diet, exercise, reduce stress, and improve your lifestyle. These include incessant marketing of unhealthy foods, especially to children and young adults; rising stress levels due to economic, national and global concerns; growing use of digital devices that are linked to longer periods of sitting; and sophisticated lobbying by the food and drug industries geared only to the health of their bottom line. It is easier to talk about which medical tests are beneficial for your health, but much more difficult to confront these ubiquitous headwinds.
49
@William
Thread winner, William. Especially the incessant marketing of unhealthy foods. We need a public awareness campaign (yesterday) linking diabetes to the milkshakes that pass as coffee drinks, McDonalds, any fast food, candy, and on and on. Just draw a dang arrow to french fries and someone hooked up to machines in a hospital to make the point.
DO IT.
5
I wish Ms Brody would use her sources to discuss the potential side effects of statins, like peripheral neuropathy. In addition, more information on the effects of vitamin K2 and its sub sets on Ca and its effects on osteoporosis and Calcium disposition in other tissues.
81
@Bill
We all need to be wary of these constant revisions to guidelines . Wasn't that long ago, there was suggestion, maybe everyone should taking statins, comparable to most now advised to take blood pressure pills, because of again revised guidelines. The numbers have now been driven down that recently were advised as acceptable.
10
@Dan Green
Guidelines get revised every 5-10 years, based on evidence. Your interpretation of what past guidelines said is incorrect. Have you read them, or the newer ones? I’d recommend that.
3
@Bill
And while providing an interesting discussion, Brody does not get fully into the issue of change "acceptable levels." That is where the detail comes forward because when the industry, doctors and Pharma, vary the scale that always appears to increase the risk and increase the promotion of statins.
It is much the same with acceptable maximum levels of blood pressure across the board and especially for older people. I have spent time examining the "gaming" of these scales as well as cholesterol and remain cynical! And yes, as someone else wrote, I fear more for Mack trucks hitting me on the sidewalk; my doctor was shocked at that but he was unable to discuss either HDL or BP with much knowledge beyond what the drug salespeople had told him.
14
Isn't there a chemical analog to HDL that is present in heavy alcohol users? And shows up as HDL in blood tests?
Perhaps this accounts for the U-shaped curve.
4
I have never had sky high HDL, but my ratios have been good and my total levels have been quite low since going on low levels of Lipitor years ago. Once a year I have my blood checked, and if I get good results, I go out and have a cheeseburger. Otherwise I generally eat pretty healthy.
4
@Paul in NJ You do understand that there is basically no real link between blood cholesterol levels and cholesterol in your food?
2
Association is not causation. Cholesterol level, taken out of the context of overall health, is a very shaky indicator.
55
@Véronique (This is Mrs. Gary) Thank you! In stats talk, it is expressed as 'correlation does not imply causation.' Knowing what I do about medical studies, I would be reluctant to accept anything in this 'revelation' until I can see the design of the study (confounding variables are a huge problem). And whether it was repeated several times with different samples.
13
@Véronique
And what is better than LDL ?
@ringo
What's better than LDL?
Well, it's not high dose statins, with more side effects than benefits.
LDL is pretty shaky--the correlations aren't that strong; but we have a pharma to control LDL, so darn it, get that LDL under control.
Right after my heart attack 21 yrs ago, my cardiologist said, it doesn't matter what your LDL level is, if you had a heart attack, it's too high.
Really? Then LDL level is meaningless as a predictor, isn't it.
1
A wonderful hidden tale of modern medical science. Epidemiologists observed an Association of HDL with cleaner arteries. Now every researcher first cautions us not to confuse Association with Causality - and then, after repeated references to the relationship, proceeds to do exactly that. The artery cleansing function of HDL is an unproved Hypothesis and, despite efforts to find actual Mechanisms of action, remains unproven.
This unmerited move from Association to Causality drives today’s cardiology. Why the Association of higher HDL with cleaner arteries? High carb diets (aided and abetted by fructose in sugar and corn syrup) cause de novo lipogenesis in the liver which produces VLDLs, which, crucially, interact with CETP in the blood to produce small, dense LDLs - and decrease HDL. As is widely recognized among heart disease researchers, these small dense LDLs penetrate arterial endothelium, setting off immune reactions which cause arterial plaque.
So HDL is just a marker; it’s the VLDLs (measured as triglycerides) that are worthy of your attention. They will plunge on a very-low-carb diet.
Forum Post: “On this type of diet I have dropped 60 pounds, dropped by cholesterol 100 points, moved my LDL to "big and fluffy", raised my HDL, crashed my triglycerides to 60, .... PS I am a physician with a degree in nutrition......everything I used to believe is wrong!”
128
@Charlierf
Yes, Yes, Yes..... Low Carb is the way to go.I am 65 and very active but headed towards being diagnosed as pre-diabetic. My numbers were not improving. Then my son told me about the amazing change he made in his eating habits and the effects it had on his annual fasting blood results. I did the same, in conjunction with a sober October. By the time I had blood work done in early Dec, my numbers had changed dramatically in a positive way. And... I also lost weight in the deal. Very Happy...
10
@Robin
Low Carb is the way to go
Absolutely!
7
I wish Ms. Brody would do a little independent research (and not simply asked her establishment buddies). Or read comments posted to her past columns. Had she done either of these things, she would know that LDL is not one lipid, but is many lipids. It is only the small, dense particles that increase the risk of coronary heart disease. And the large and fluffy type of LDL may be protective. Or at least they are benign.
The types of LDL can be measured with a VAP test. But a good guess can be made based on the ratio of HDL and TGs (when not taking any cholesterol lowering drugs). If your HDL is the same or greater than your TGs, your LDL will be mostly large and fluffy. And you have nothing to worry about.
If it weren't for the pharmaceutical companies demonizing LDL in order to sell their drugs, we would be more focused on the HDL/TG ratio, which would show that a low carb diet is best for heart health.
68
@Don Wiss
Excellent comment. You informed my understanding much better than Ms. Brody on this continuously bewildering subject.
11
@Don Wiss
As usual the wisdom is to be found in the comments.
8
Why test children for HDL/ LDL if meds (Vytorin mainly) aren't prescribed to them?
I assume "everyone" is encouraged to be on the "healthy lifestyle" diet.....
Other tests recommended for adults in the article probably won't be covered by insurance and/ or medicare......
3
@RLiss
The reason to test them is to find those with genetically very high levels early in life so they can be treated. While uncommon, these are not rare findings, and these are the people with familial hypercholesterolemia and related disorders who can heart attacks in their 20s and 30s. Early treatment is essential. The timing (age) of screening depends in part on family history. And yes, everyone is encouraged to be on healthy diets, high in vegetables and fruits, with moderate intakes of lean proteins and whole grains, and inclusion of healthy fats.
2
@Kay jones
so they can be treated.
Really? Put kids on statins for life ? What a terrible idea.
1
Kay is right. If they have FH, you need to get them on something early or their lifespan will be very short. So the answer is yes, when needed. Uncommon but critically important.
1
Authoritative organizations like American College of Cardiology or American Heart Association that are heavily sponsored by the pharmaceutical industry have been changing their advice and have the general public more confused as a result. This HDL story is no exception. They have rarely explained the public that heart attack or stroke occurs because of atherosclerosis, a complex and chronic inflammation of artery. They are gradually less pushing statin and recommending lifestyle change because simplistic cholrsterol-lowering statin does not solve the problem because of the complexity of the disease. They are facing serious limitation of their medicine-dispensing approach based upon the symptoms. They argue that "lifestyle change" is necessary. Since when medical schools started teaching "lifestyle change" such as nutrition, supplementation, sleep management, stress and anger management, exercise etc. ?
23
Bone density testing, pre-diabetes, high cholesterol are all ways for the medical industrial complex to make more money and big pharma to sell more drugs. Doctors rarely mention healthy diets and exercise before writing a prescription.
46
@Jacquie - gonna push back on the "Doctors rarely..." line. I think in many cases doctors who have long term patients do make those suggestions, or maybe know their patients so well, they know such a suggestion will get a lot of head nods, but near zero compliance.
Could also be that many more people then ever before don't have a primary care doc, but instead, as the trend now is, visit these newer strip-mall, stand alone, clinics, etc, and are seeking the quick fixes and not lifestyle changes. Like getting coffee, they want to get in and out, "give me a pill!"
Then there are the patients who know everything anyway, and know they don't need a lifestyle change, and doctors are just quacks anyway! The; "I've been living this way my whole life, my daddy lived to 99!" types. Which an experienced clinician can spot a mile away. Give 'em the pill, that's what they came in for, give 'em what they want.
21
@Boregard These book and many others written by doctors have good information on the overdosing of Americans on drugs many do not need.
https://www.goodreads.com/book/show/220314.Overdosed_America
https://www.amazon.com/Over-Dose-Against-Companies-Prescription/dp/1585421235
5
Same old same old. No one says that 1/2 of heart attacks happen in those with low LDLs. No one says that if you take statins your heart attack risk goes down marginally but your total risk of dying goes up. No one says that if you take statins that your risk of diabetes, cancer, and Alzheimer's goes up. No one says that there is more than one kind of LDL and your profile of LDL may be more or less risky. And all most no one can lower their LDL to the new levels by "lifestyle" changes. Talk to a functional cardiologist!
153
@HJL
No one says most of the bad outcomes you list because the evidence indicates they are not true.
12
@Kay jones In truth, it is precisely because the outcomes she so carefully named are found in the adverse event data drug company scientists are forced to collect, by FDA law.
6
@HJL
Statistically, it would seem that one's total risk of dying is independent of any of the drugs one takes, the food one eats, or the amount of physical exercise one does.
4
Regarding cholesterol levels in general, health professionals, nonprofit organizations and the federal government have all been advising Americans for decades on effective ways to lower cholesterol through lifestyle changes. It is frustrating to confront the steady messaging from self-styled gurus who profiteer by spouting hogwash about both the benign level of LDL and the magic of high HDL. Many of their acolytes can be found right here, consistently downplaying LDL as a major risk factor for cardiovascular disease. So it is good to see some countering information making its way into the New York Times.
5
@childofsol
Cholesterol lowering through diet (by eating more plant oils and less animal fats) has been tested extensively for decades, and it succeeds in lowering cholesterol. But it has never been demonstrated to be protective against heart disease or overall mortality. In recently uncovered "buried" studies from the 1960s-70s, cholesterol-lowering through diet _increased_ heart disease.
https://www.nytimes.com/2016/04/16/upshot/a-study-on-fats-that-doesnt-fit-the-story-line.html
8
@childofsol
Exhibit A. Clockwork.
To refine my original comment, many decades and dollars have spent educating the public about maintaining low LDL cholesterol. Prevention is always more effective than attempts to cure disease.
There are some phenomena which are often overlooked when interpreting scientific research, and in some cases, in the research itself. 1. It takes decades to develop into a metabolically unhealthy person. 2. Reverting back to good health similarly requires time, and some of the damage done is likely to be permanent. 3. Most studies are short-term in nature, and there is often little discussion of the relative merits of short-term vs longer-term studies. 4. Western medicine is superb at keeping very sick people alive, for years if not decades. With that in mind, clear distinction must be made in one's mind if nothing else, between mortality and morbidity. 5. Average numbers are often confused with optimal numbers. This can be seen with cholesterol levels; an American with average cholesterol also has high cholesterol. The very sick nature of our populace also causes even medical professionals and scientists to either forget what is "normal" or optimal, or to go small rather than go as far as they should in their recommendations - with respect to diet, exercise, cholesterol, etc. One example: dietary recommendations to aim for at least 50% whole grain consumption, which is far from optimal, but much greater than average consumption.
5
@childofsol
To continue: The majority of the population is overweight, and it's a good bet that at least half have abnormal metabolic health. This lends itself to research that is not only dominated by how to cure the metabolically sick, but to studies which compare not apples to oranges, but seriously bruised apples to rotten apples so to speak. Many unwarranted conclusions can arise from such comparisons. As we have learned more about these diseases, whether diabetes, heart disease, Alzheimer's, it has become clearer that disease processes occur much sooner than the disease presents. It has, in my opinion anyway, become increasingly difficult to find controls who are in fact healthy. This problem is compounded even further by controlling for variables which are not truly independent variables. All of these issues means that it is important that we not only include many types of studies, but that we - with our short attention spans and infatuation with the novel - acknowledge the relevance of older studies, including epidemiological studies.
9
There was a very interesting scholarly article about a decade ago or more that went largely unnoticed. It demonstrated that 1) primitive hunter gatherers still around tended to have LDL in the range of 50 to 70 and 2) at about LDL 57 there was neither a further accumulation of plaque in the arteries nor reduction of existing plaque, but below 57 LDL the clogging began to reduce, though it took years. It was solid evidence that it's possible to reduce existing coronary artery disease, as well as an indication of what is "normal" for human beings.
2
@Peter1919
- hard to draw correlations between primitive hunter gatherers to "normal" modern humans.
Its like comparing a life-long, true athlete, to someone who starts exercising seriously in their 50's.
3
One study does not maketh enough evidence to change recommendations. Plus, correlation does not equal causation. Sorry, buddy.
3
There's so much key information packed into this article that I wish The Times had given Ms. Brody three separate columns in which to deal with it all; to separate the new findings into bite-sized meals-of-consequence.
My own bias is that this paragraph could have been the lead here:
"...Everyone with high cholesterol may not need drug therapy to lower this harmful blood fat. In fact, unless LDL levels are astronomically high or the person has known heart disease, treatment should not begin with a drug but with lifestyle: a heart-healthy diet, physical exercise and, if needed, weight loss. Only when these fail to lower cholesterol should drug treatment be considered, the [new] guidelines state."
Ms. Brody has been crusading for healthy lifestyles in her personal columns here for many years, but it's still a major chunk of information, and a new direction, that's now offered by top scientists. For them, better late than never, but they are only beginning to grasp it all.
(I have such an aversion to statins-therapy due to potential side-effects that when my physician finally convinced me to confront an 8-to-1 *negative* bad-cholesterol vs good-cholesterol reading a while back, I was willing to dramatically alter lifetime habits of meals of beef and garbage. Took about 18 months, but a steadily-decreasing ratio motivated me and today that ratio stands at a negative 2-to-1. Dinner hour is much less fun, lacking red meat and deep-fried-anything, but it's worth it.)
33
@Make America Sane
Good for you!
You are doing exactly what the guidelines have recommended for a long time actually, but that doesn’t get conveyed in short news articles. The decision to move to medication should be taken thoughtfully for sure, and must have a healthy lifestyle as the prerequisite.
6
@Make America Sane Then there are those who argue that their all-meat diet has reduced their cholesterol to zero. Meat bad! Meat good! Eggs bad! Eggs good!
It's no wonder the average American looks at this constant flood of confusing and contradictory "information" and throws up his hands in resignation. The media need to stop presenting studies' suggestions as facts. And readers need to dig into the actual studies. It's still confusing, but at least you can be reasonably confident you're getting the information the study intended, rather than bloated and distorted headlines.
1
For most people it is not the LDL nor the HDL level that matters but the ratio of the two. I took a look at the articles mentioned and had a hard time finding any data that elevated HDL can increase your risk of cardiovascular disease except when extremely high (greater than 134 in women very rare). It is interesting to note that whole milk, cheese and butter raise HDL. Seems like this article is in the camp of 'keep your low-fat diet' and don't listen to the crazy butter lovers. But I do love butter and I didn't find anything in this article to convince me to not raise my HDL with dairy.
44
"The guidelines emphasize the importance of personalized care, not cookie-cutter prescriptions based solely on blood test results."
4 days ago, the NYT had a story about Epic Systems where a multitude of commenters decried the inflexible boilerplate information technology that wasted the time of doctors and nurses.
How is a personalized approach possible in an impersonal environment ?
The reasons for avoiding doctors continue to accumulate.
30
This falls under Catherine Tate's "Run for your lives, children: We're all going to die!"
20
A New York study in 2010 found an association between HDL-C >55mg/dL and decreased risk in the elderly of Alzheimer's dementia. https://jamanetwork.com/journals/jamaneurology/fullarticle/801799
However, treatment with statins or other drugs to raise genetically lower HDL levels (as with ApoE4 carriers) hasn't been found so far to prevent AD, although CVD and vascular dementia risk is elevated in ApoE4.
As the Ms Brody reports, you are advised to consult with your personal physician. Unfortunately, Medicare and other insurance likely won't pay for cardiac calcium scans without other evidence.
16
@joeshuren
Actually, statins do lower the risk of dementia, especially vascular based dementia. And since Alzheimer’s is accelerated substantially by vascular phenomena, it’s not a bad idea to consider them if you have either high LDL or high risk for atherosclerotic cardiovascular disease
2
oh look another it only works like this myth laid to rest.
3
This is a very confusingly written uninformative article. The headline is HDL Cholesterol:Too Much of a Good Thing, but most of the article discusses LDL and lifestyle choices to lower LDL. High (LDL or total) cholesterol is not the same as high HDL.
There is no discussion about what you can do, if anything, to lower HDL. Apart from the fact repeated several times that high HDL seems to be bad for you there really isn't anything else about HDL in the article. Does following a "healthy" lifestyle lower high HDL? Anybody quickly reading this article could come away with the idea that it does.
138
@Judith Yes, eating a less processed more whole food plant-based diet can lower total cholesterol, LDL AND HDL. As a telehealth RN, I have seen this many times and have to reassure patients that having a lower HDL along with a lower LDL after they gave made healthy lifestyle changes is NOT a problem.
23
@Judith
This is a good observation. I assume the author didn't mention how to lower a high HDL because it's not readily known how to do that specifically. She does stress that one should not seek to artificially pump it up. Seems likely that the avg person, with no intervention, probably has too low an HDL anyway.
3
@Judith
As always it’s more complicated than “high HDL cholesterol is bad.” It is bad for a subset of people, not for everyone, and that’s what generates the u shaped risk curve. Many people who have very high HDL cholesterol are doing great and there is no evidence that you should try to lower it, nor healthy/good strategies for doing so. If high HDL cholesterol is occurring as a result of excessive alcohol intake, or occurring in the setting of diabetes, high other risk factors, or a strong family history of cardiovascular disease, it may mean its risky, so the best thing to do is to make sure all other risk factors are very well controlled and lifestyle is optimal.
17
Lots of exercise for many years, a mostly Mediterranean diet, moderate wine consumption and mindfulness meditation, plus taking a statin have given me an HDL level over 100 and an LDL in the upper 80s.
Should I consider taking more statins or other drugs to lower my HDL level at 70 years old? Should I be worried? Well I'm not.
Despite all that medical science has learned about cholesterol, I suspect there is much more we don't know. Live right and let the cholesterol numbers fall (or rise) where they may.
93
I'm in about the same place: 68 years old, avid cardio exerciser for decades, eat a plant based healthy diet, like my wine and beer, have no family history of heart disease, and have never been on any medications. My total cholesterol has always been in the low 200s with HDL about as high as LDL and for my last couple of physicals, my HDL has been a bit higher than LDL. What shall I do? Perhaps the drug companies will come up with something to save me before I die.
20
@a goldstein Too high HDL can apparently be bad for you. My half-sister has about 120 HDL number. That is abnormal and she has various health problems. Here's an article from the NYT to read:
---------
Can Your 'Good' Cholesterol Be Too High?
AUG. 29, 2017
https://www.nytimes.com/2017/08/29/well/live/can-your-good-cholesterol-be-too-high.html
Also try searching: hyperalphalipoproteinemia
2
Are these cholesterol recommendations also appropriate for the elderly?
9
@Catherine The ACC/AHA guidelines presented in the article do not apply to primary prevention for those over 75. For a discussion about that point, see Paula Span, "You’re Over 75, and You’re Healthy. Why Are You Taking a Statin?" at
https://www.nytimes.com/2018/01/05/health/statin-over-75.html
5
@joeshuren
Actually the new guidelines, released in November 2018, as well as the 2013 guidelines, do address the appropriateness of drug therapy in those over 75. Helps if you read them.
2
According to Dr. Allard-Ratick, "With LDL, there is no sweet spot."
Seemingly there is no adaptive purpose to LDL particles, and they only exist to give us heart disease. If only we could get LDL down to zero! Then we would be immune to heart disease and live forever.
In a weird coincidence, LDL has been very profitable to medicate.
77
LDL is probably beneficial in certain situations, such as a growing baby breastfeeding. It’s not helpful for middle-aged men who can easily overeat, which is why high LDL is such a problem these days. We didn’t evolve in an environment where it was so easy to eat more calories than we need.
22
There are two types of hdl. One us protective the other isn’t. The article fails to say if this was determined in the study cited.
2
@Nick
Well-stated. What you have described quite sensibly is a possible "sweet spot" for LDL, with an adaptive purpose (fat energy delivery), and a allowance for variation between individuals.
This is quite contrary to the mainstream medical view expressed in the article.
6