One of the better ways to lower your LDL and triglycerides is to have the lowest percent body fat reasonably possible, recognized as abdominal clear lines of definition and demarcation: CLOD/D. You could be a little more supportive of being vegan or even 85% vegan, limiting animal protein of any type to 3 palm sized servings a week in those who are trim and less in those with some degree of overweight. Do not confuse the Mediterranean diet as being very beneficial for heart disease: it only lower stroke and not significantly myocardial infarction or all cause mortality. There is a Vegiterranean diet in which people eat large quantities of vegetables, mostly soups and stews, ideally made with beans such as lentils, chickpeas, black eyed peas, white kidney beans…. BTW: FABULOUS DISCUSSION-one of your best!!. HRS, MD, FACC
Very clear explanation of LDL-C, VLDL and the conversion to LDL. So I’m a very extremely older (64) male who loves a few beers and a cocktail and was not aware that my alcohol consumption could be the reason for higher LDL and maybe APO-B (93). I’m not a lumberjack, but I want to be “ok”. Would taking a PCSK9 inhibitor be a good option considering I also have McArdles disease? Just as changing the diet is very hard, so is not being extremely active and enjoying the adult beverages.
Our studies do not find many muscle problems with statin treatment, but of course we did not study statin use in patients with McArdle's disease, which is the inability to break down and then use skeletal muscle glycogen for energy So, I agree, a PCSK9 would be a good choice, but your personal doc must decide.
Thanks for all the info. I knew there were options. I just thought the PCSK9 inhibitors were really the best choice since I could not use a statin.
My last labs showed an Apo A1 of 158, APO B of 97, and non-HDL of 130. Lipoprotein a >10. A1C 5.6. The CT calcium score total 77.9 and volume of 64.8. (My only understanding of those scores is that it indicates mild atherosclerotic plaque.
Where would you like to see the APO B and do you think that is the best marker of risk?
It's a little hard to comment from a distance, but generally I would want your LDL-C near 70 and your apo B near 80. You don't sound very risky to me. P
David: To decide what to do with you we need to know what your risk of heart disease is: what are your lipids, what is your lipoprotein a, what is your glucose/hemoglobin a1c, and do you have coronary calcium.
If it appears you should be treated, there are several good choices. Ezetimibe blocks cholesterol absorption in the gut and alone reduces LDL about 20%. It generally does not have muscle issues. Bempedoic acid reduces LDL about 28% when used alone, about 17% when combined with a statin, and about 50% when combined with ezetimibe. Bempe is given as a predrug and has to be activated by the liver. If it escapes the liver, the muscle cannot activate it so it should not do anything to your muscles. Colesevelam blocks bile reabsorption and reduces LDL about 17%. So there are choices. PCSK9’s are excellent choices, but not the only one.
Excellent read. As an endurance athlete since I was 16, ranging from Marathons to Ironman's and more, and eating a mediterranean diet 80% of the time, I still could not escape the genetics my parents passed on. The delay of the impact on myself was decades later then when my father experienced it, yet still ending up at the same place. As I read articles like this one, I pass on the information to my kids to help their futures. I would love to hear more on PCSK9 inhibitors and the progress of Lp(a) drugs being worked on for high Lp(a) - another genetic gift bestowed upon me. 🤣 Thank you for your articles.
Interesting read! I also find my patients who are drinking energy drinks/soda on a regular basis have high triglycerides and cutting out the soda fixes this almost immediately.
One of the better ways to lower your LDL and triglycerides is to have the lowest percent body fat reasonably possible, recognized as abdominal clear lines of definition and demarcation: CLOD/D. You could be a little more supportive of being vegan or even 85% vegan, limiting animal protein of any type to 3 palm sized servings a week in those who are trim and less in those with some degree of overweight. Do not confuse the Mediterranean diet as being very beneficial for heart disease: it only lower stroke and not significantly myocardial infarction or all cause mortality. There is a Vegiterranean diet in which people eat large quantities of vegetables, mostly soups and stews, ideally made with beans such as lentils, chickpeas, black eyed peas, white kidney beans…. BTW: FABULOUS DISCUSSION-one of your best!!. HRS, MD, FACC
Very clear explanation of LDL-C, VLDL and the conversion to LDL. So I’m a very extremely older (64) male who loves a few beers and a cocktail and was not aware that my alcohol consumption could be the reason for higher LDL and maybe APO-B (93). I’m not a lumberjack, but I want to be “ok”. Would taking a PCSK9 inhibitor be a good option considering I also have McArdles disease? Just as changing the diet is very hard, so is not being extremely active and enjoying the adult beverages.
Our studies do not find many muscle problems with statin treatment, but of course we did not study statin use in patients with McArdle's disease, which is the inability to break down and then use skeletal muscle glycogen for energy So, I agree, a PCSK9 would be a good choice, but your personal doc must decide.
Thanks for all the info. I knew there were options. I just thought the PCSK9 inhibitors were really the best choice since I could not use a statin.
My last labs showed an Apo A1 of 158, APO B of 97, and non-HDL of 130. Lipoprotein a >10. A1C 5.6. The CT calcium score total 77.9 and volume of 64.8. (My only understanding of those scores is that it indicates mild atherosclerotic plaque.
Where would you like to see the APO B and do you think that is the best marker of risk?
It's a little hard to comment from a distance, but generally I would want your LDL-C near 70 and your apo B near 80. You don't sound very risky to me. P
That’s good to hear because I’m physically active and I’d like to drink to that. Thanks for your insight!
David: To decide what to do with you we need to know what your risk of heart disease is: what are your lipids, what is your lipoprotein a, what is your glucose/hemoglobin a1c, and do you have coronary calcium.
If it appears you should be treated, there are several good choices. Ezetimibe blocks cholesterol absorption in the gut and alone reduces LDL about 20%. It generally does not have muscle issues. Bempedoic acid reduces LDL about 28% when used alone, about 17% when combined with a statin, and about 50% when combined with ezetimibe. Bempe is given as a predrug and has to be activated by the liver. If it escapes the liver, the muscle cannot activate it so it should not do anything to your muscles. Colesevelam blocks bile reabsorption and reduces LDL about 17%. So there are choices. PCSK9’s are excellent choices, but not the only one.
Great article! I am surprised how well the complex lipoprotein metabolism was explained!
Thank you so much. It's pretty simple, actually. Keep reading because we'll deal with similar issues again later. Paul
Excellent read. As an endurance athlete since I was 16, ranging from Marathons to Ironman's and more, and eating a mediterranean diet 80% of the time, I still could not escape the genetics my parents passed on. The delay of the impact on myself was decades later then when my father experienced it, yet still ending up at the same place. As I read articles like this one, I pass on the information to my kids to help their futures. I would love to hear more on PCSK9 inhibitors and the progress of Lp(a) drugs being worked on for high Lp(a) - another genetic gift bestowed upon me. 🤣 Thank you for your articles.
Thank you for the kind comments. I will try to address more of this in the future.
Interesting read! I also find my patients who are drinking energy drinks/soda on a regular basis have high triglycerides and cutting out the soda fixes this almost immediately.
Great comment. I have not seen this, but it does make sense. They take the sugar, make acetyl Co A and then triglycerides. Thank you.
Excellent review Dr. Thompson. Thank you for teaching us
I do hope these help. My goal is to teach as you know. Paul