Studies are now bringing to light that there are at least 7 types of LDL cholesterol; some of them thought to be harmful and some of them thought to be beneficial. Generally, the smaller the particle size, the more harmful it is thought to be. Why don't they break down LDL readings to show how much of each type a person has? Cost is the primary reason. Also, very few labs are set up to actually perform that type of specialized test.
I also tend to lean towards the theory that cholesterol levels are symptomatic, not causative, of a potential problem. Here's a few things to think about along those lines:
-Cigarette smoking causes a rise in LDL and a drop in HDL. There's no fat in a cigarette, so why the impact on cholesterol readings? My hunch is inflammation caused by the chemicals in the cigarette and damage to the lung tissue. What are some dietary causes of tissue damage? A diet high in free radicals (damaged oils), transfats (even in small amounts), and sugars (free radicals again) as well as low in antioxidants.
-A sudden drop in cholesterol levels can be an indicator that there is a serious disease process going on. Often in cancer patients, a sudden drop in cholesterol levels is noted. Here's a situation where lower cholesterol is not a sign of good health...just the opposite.
-The Framingham study indicated that those who had the highest saturated fat intake also tended to have the better cholesterol levels overall. If saturated fat is such a dietary evil that causes heart disease, why is this?

As for telling newbies not to sweat an increase in total cholesterol levels, that does sometimes happen, but also with the advice to take a look at the whole picture and not just the total before allowing panic to ensue. A rise caused by an increase in HDL is not a bad thing. Even a rise from an increase in LDL may not be a bad thing if it is being caused by a shift from the small particle LDL to the larger particle LDL. There's also other factors to consider such as triglyceride levels, C-reactive protein, ratios, etc...
I also find myself wondering if those who do see an unusual increase in total cholesterol or an increase in LDL are eating a lot of low carb products which often have transfats in them....

Lisa N,

Thanks for that..tends to confirm my own thoughts about it. My own readings show very high HDL, but also very high LDL, but with excellent Total/HDL ratio and rockbottom triglycerides, and normal CRP and homocysteines, plus I am over 60. A recent study showed CRP to be a better indicator of CHD in a group of women (nurses?) than lipids.

Val

That was the Harvard Nurse's Study.

Val,

Do you know of anyone who has tested for LDL Density Pattern? Seem like not a lot is know about it but this company will test for it.

www.gsdl.com

Larry

Larry,

Someone posted this question on the cholesterol forum but got no replies. I live in Australia and its not done here as far as I know. I do wish some of you over there who have been on LC for long enough would test this out!

Val

A NEW MEDICAL RIDDLE FOR THE 21ST CENTURY

Or How Cholesterol Doublethink Will – And Should – Drive You Crazy

By RFD Columnist Dr. Malcolm Kendrick
(email - malcolm~llp.org.uk)

Question: ‘How can something be a risk factor for a disease, when it isn’t even there?’ This is my new medical riddle for the 21st Century.

Or, try this question instead. What is a raised cholesterol level? You might think there is an answer to this question – but there is not.

Currently, we have an alleged risk factor for heart disease – a raised cholesterol level – which must be lowered. But no-one will tell you what a raised level is, or by how much it should be lowered. Whatever the level may be, it would seem, you must lower it.

You may have heard about the latest Collaborative Atorvastatin Diabetes Study (CARDS).This study, halted early, looked at giving atorvastatin (Lipitor) to people with diabetes, and found wondrous benefits; with an interesting rider:

‘One important finding was that these benefits were observed even among patients whose ‘bad' LDL cholesterol levels were already quite low before treatment. People with type 2 diabetes have a much higher risk of cardiovascular disease but are currently only prescribed statin treatment if their cholesterol levels are raised.’

- Professor John Betteridge, CARDS co-principal investigator and Professor of Endocrinology and Metabolism at University College London

People with low cholesterol levels benefited from having their cholesterol levels lowered? Doesn’t this seem strange? The whole point of statins was to lower the cholesterol level in order to prevent CHD. And it’s true that statins do lower cholesterol levels, and they do prevent CHD. They even reduce overall mortality in high-risk men – although not in women, or low-risk men.

Yet they also protect against CHD in people with low cholesterol levels. So what is going on here? Can a low cholesterol level be a risk factor for CHD? This surely makes no sense at all. And yet this fact is not commented on. I have seen many reports on the CARDS trial, and no-one, not one single person, has questioned the fact that statins work in people with low cholesterol levels. Perhaps it would seem rude, or churlish to do so.

However, at the risk of sounding “not-nice,” I believe that this single fact should completely destroy the entire cholesterol hypothesis. According to the CARDS data, and many other studies as well, statins work no matter what the level of cholesterol. Ergo, they do not work by lowering cholesterol levels, as a low level of cholesterol cannot, by definition, be a risk factor for heart disease. What is going on here? Hello……. Can anyone hear me?

I don’t suppose when George Orwell wrote 1984 he truly thought that most of what he wrote would come true. It was supposed to be a warning. One thing he warned us of was double-think.

‘Doublethink means the power of holding two contradictory beliefs in one's mind simultaneously, and accepting both of them. The Party intellectual knows in which direction his memories must be altered; he therefore knows that he is playing tricks with reality; but by the exercise of doublethink he also satisfies himself that reality is not violated. The process has to be conscious, or it would not be carried out with sufficient precision, but it also has to be unconscious, or it would bring with it a feeling of falsity and hence of guilt.’

In the strange Orwellian world of the cholesterol expert, double-think goes like this.

‘A raised cholesterol level causes heart disease.’
‘What about people who have heart disease and a low cholesterol level?’
‘There is no lower limit for a cholesterol level, so one cannot have a low cholesterol level.’
‘So, the level should always be lowered, no matter what it is?’
‘Correct.’
‘So the cholesterol level is always high.’
‘Correct.’

Possibly you think that I am making this nonsense argument up. But I am not:

Consider the following quote from the British Medical Journal taken from an article by Professors MR Law and NJ Wald two years ago which made the following observation:

‘Blood pressure lowering drugs should not belimited to people with high blood pressure, nor cholesterol loweringdrugs to people with high serum cholesterol concentrations. Theconstant proportional relation means that there is value in modifyingrisk factors in people at high risk, whatever the reason for thehigh risk and regardless of the level of the riskfactor.’

I have tried reading that paragraph slowly, quickly and both sober and drunk, and it still makes no sense to me at all. Because, you see, I am incapable of double-think. My brain must be too small.

I apologise a little for including the blood pressure comment in the quote, but the whole thing so perfectly illustrates the double-think point that I didn’t want to change it.

Anyway, let us use a little logical dissection to find out what this quote really says?

‘Blood pressure lowering drugs should not be limited to people with high blood pressure, nor cholesterol lowering drugs to people with high serum cholesterol levels…..’

Let’s assume, for the sake of argument (concentrating only on cholesterol) that a cholesterol level must, at some level, be normal. Call me an old cynic if you like, but I don’t believe that a normal level of anything can be a risk factor for a disease. Or, if it is, we must be terribly badly designed. Try, for example, lowering a normal level of potassium in the blood and see how long you live.

And if a normal level isn’t a risk factor, then the cholesterol level can only be a risk factor when it is high. I think this is inarguable logic. If it isn’t, then perhaps someone would be kind enough to enlighten me as to the error of my ways.

The first question, therefore, should be to establish what is normal, and what is high. But this step is not required; it would seem, in the world of cholesterol levels. For the second part of the quote states:

‘The constant proportional relation means that there is value in modifying risk factors in people at high risk, whatever the reason for the high risk and regardless of the level of the risk factor.’

Just concentrate on the second part of that quote…’regardlessof the level of the risk factor. In short, whatever the level of your cholesterol, it is a risk factor. Which means that there is no such thing as normal, for normal, if it is a risk factor, must be high. Because if it wasn’t high, it couldn’t be a risk factor as normal is….normal and healthy.

So, according to Law and Wald, a normal cholesterol can be both normal, and also a risk factor for heart disease. And now we find in the CARDS study that a low cholesterol level can be low, and also a risk factor for heart disease.

Thus a cholesterol level is a risk factor, no matter what the level actually is. Which brings me back to my riddle. ‘How can something be a risk factor for a disease when it isn’t even there?’ The answer is, when it is a raised cholesterol level. How silly of you not to have guessed.

For those whose heads are now spinning, just read the whole article again slowly, I assure you it does make sense. At least it did to me.


One of my favorite "skeptics". Enjoy!

Been awhile since I read up on all this, but I believe they already have identified a better marker. It's called lipoprotein-a, and IIRC, it isn't LDL which is found in plaques, but lipo-a.

"The MRFIT study characterized
361,662 men aged 35 to 57 and clearly shows a connection
between total cholesterol and incidence of heart attack.If
you lower your cholesterol from 240 to 200 you have cut your
probability of a heart attack in half according to MRFIT."

Actually, the data does NOT show this. The data shows that people with a cholesterol of about 200 do have about half the risk of people with a level of 240. Basically, you go from a risk of maybe 4% to maybe 8%.

The data does NOT say, however, that if you LOWER cholesterol from 240 to 200, you will reduce the risk. MRFIT did NOT look at this. That is a wild-ass guess. That's an assumption, not a fact.

a: There are PLENTY of people who have cholesterol over 240, yet DO NOT develop heart disease.

b: there are PLENTY of people with cholesterol under 200 who DO get heart disease. Had dinner with one the other night. His cholesterol has been 180 FOREVER. He has already had two bypasses. When he asked his DR why, the Dr just shrugged. "Must have been something else."
"Like what?"
"Don't know."

Like inflammation? Is he a big low fat fan?

Val