for a diabetic, they want our LDL levels to be
below 75 now

you have good ratios, but that's not enough

i don't have a reference other than this group for
that information

kate

This post not CC'd by email
On Mon, 20 Mar 2006 10:37:55 -0500, bittersweet

G'day G'day Bittersweet,

Thank goodness I had a good nights sleep before waking to a challenge
like this. I'm not a doctor.  I don't have your full medical history
and family history etc that your doctor has. All I can offer is to
look at it for whatever educational value there might be in it for us
all.  

Firstly let me compliment you on your achievements which are
considerable.  You have RAISED your HDL from 40 to 58.  That is a 45%
rise.  Raising HDL is difficult.  For me it has been next to
impossible.  My GP says that is genetic.  I once walked up Dobell hill
for most days of a month in order to push up HDL by the standard
techniques of exercise and more exercise.  I got fitter but the HDL
did not budge.  Since I didn't smoke, I couldn't give up smoking.
Initial weightloss had helped by a few percent.  What I'm trying to
say here and perhaps not to elegantly is that you have made a
considerable improvement to you expected future health and it shows
even when we look at one single aspect of your blood test.

If we look at TG:HDL we see you have gotten a ratio of 1.3   That is
phenomenal.  Statins often help with the LDL and even HDL but often
don't do jack for the triglycerides.  Most people are happy if with
American units they get below 3.  Can you see me smiling wryly as I
notice that you have set the IDEAL goal of under 2 as YOUR goal.
Doctors don't often use TG:HDL as a predictive ratio.  
IMHO they should.

Please excuse the lengthy explanation.

Risk of coronary heart disease is somewhat loosely correlated with
cholesterol levels. Even LDL levels have only a relatively loose
correlation.  The hidden reason is that some LDL is more dangerous
than some other LDL.  The body recognises danger. It responds to
danger.  When LDL is oxidised the body produces antibodies to this
oxidised LDL.  This is the LDL the body knows to get rid of to ensure
survival.  How the antibodies recognise the oxidised LDL I don't know.
How we can recognise oxidised LDL is somewhat simpler.  The oxidised
LDL is smaller and denser. It is known in the literature as sd-LDL.
It is well established that sd-LDL has TWICE the risk factor of LDL.

How can one know whether one's LDL is predominantly sd-LDL?  

The question isn't academic in your case.  

Statins tend to reduce the levels of the big fluffy relatively
harmless LDL first. The sd-LDL is the nasty stuff that statins don't
get so well unless one ups the dose of statin or uses a superstatin.
In your case there are grounds for confidence in your having gotten to
the sd-LDL   It is that fabulously low TG:HDL ratio.  
Run it past your thinking again and again.

Your TG:HDL ratio is fabulous, better than what is regarded as ideal.
It is a powerful indicator that your LDL is not sd-LDL.

These days I don't much like discussing cholesterol.  The reason is
that by itself it correlates relatively poorly with CHD.  When
cholesterol lowering drugs were introduced they reduced cholesterol
but didn't reduce CHD deaths. That was until statins entered the
scene. Statins worked to reduce cholesterol. Statins worked to reduce
CHD mortality BETTER than could be accounted for by the cholesterol
hypothesis.  It was obvious to all in sundry who bothered to look at
the situation that it was doing something else, something MORE
IMPORTANT than lowering cholesterol which lowered morbidity. When the
pharmaceutical companies became aware that statins weren't initially
getting the sd-LDL their response was to advocate lower levels of
acceptable LDL.  It's not a bad strategy though it is reminiscent of
the management motto, "When the screw won't turn, buy a bigger
hammer."

Research on statins has preceded in many directions eg reduction of
deaths from flu.  Statins appear to work in the field of inflammation.
The latest recommendations for diabetics appear to be to recommend
statins when either LDL is higher than 70 or C-reactive protein is
above 2 ppm (Two parts per million) CRP is a marker for silent
inflammatory disease.  We didn't hear anything much of the C-reactive
protein, CRP until the statin manufacturers found they were the
pharmaceutical answer to them. Strange that.  

The nutritional answer has been around for yonks.  Eat greens cooked
with olive oil and/or use high grade canola or mustard seed oil that
hasn't been partially hydrogenated for cooking. Oh, and there are the
other anti-inflammatory strategies to be found in nutrition.  Lowering
blood glucose is an important part of that. It is hardly surprising
that A1c has been found by some researchers to be a better predictor
of arterial health than cholesterol.

Best wishes,

bittersweet wrote in message ...

 Comments on total to HDL ratios and LDL to HDL ratios are scattered all
over the web,  e.g.

Total Cholesterol/HDL ratio:  http://www.exrx.net/Testing/LDL&HDL.html

LDL/HDL  ratio:
http://www.fatfreekitchen.com/cholesterol/cholesterol-ldl-hdl-ratio.html

It seems that every site has its own opinion.    The recommendations can
easily vary by 10%  from site to site.     I have seen 4.5 and 4.0 for the
total/HDL ration and 3.5 and 3 for the LDL/HDL ratio.

This site has 1997 total/HDL and LDL/HDL vs mortality data which lead to
more liberal guidelines

http://www.chd-taskforce.de/pdf/sk_procam_04.pdf.

Triglycerides to HDL Ratio:

abstract
http://tinyurl.com/b9e8t

article
http://care.diabetesjournals.org/cgi/reprint/23/11/1679   article

A trig/HDL ratio greater than 1.33  in mmol/L  units ( 3.0  in mg/dL units)
correlates with undesirable LDL particle size distribution.

". . . .A cutoff point of 1.33 for the TG-to-HDL cholesterol ratio
distinguishes between patients having small LDL values better than TG cutoff
of 1.70 and 1.45 mmol/l.
CONCLUSIONS -- The TG-to-HDL cholesterol ratio may be related to the
processes involved in LDL size pathophysiology and relevant with regard to
the risk of clinical vascular disease. It may be suitable for the selection
of patients needing an earlier and aggressive treatment of lipid
abnormalities.
Diabetes Care 23:1679-1685, 2000"

General statement about danger of high trig/HDL ratio

http://www.medscape.com/viewarticle/448536_4

". . .High TG/low HDL-C is closely linked to the occurrence of an increased
amount of TG-rich lipoproteins, some of which are atherogenic, leading to
progression of coronary artery lesions.. . ."

Regards
 Old Al