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Medical Forum / Diseases and Disorders / Diabetes / March 2006Lifelong Reduction in LDL Cholesterol Markedly Cuts Risk of Coronary Events
http://www.medscape.com/viewarticle/528360 "NEW YORK (Reuters Health) Mar 23 - Long-term reductions in LDL cholesterol levels can reduce the risk of coronary heart disease (CHD) by as much as 88%, new research suggests. The findings also indicate a possible new target for lipid-lowering therapy." Really need to read the whole article. >http://www.medscape.com/viewarticle/528360 > [quoted text clipped - 5 lines] > >Really need to read the whole article. Maybe this will help. First, in the report it says: "the researchers looked at the risk of CHD events in nearly 13,000 subjects enrolled in the Atherosclerosis Risk in Communities study. The subjects were followed for 15 years and were divided into two groups based on whether they had sequence variants in a gene called PCSK9, which have been linked to low LDL cholesterol levels." So, actually, it's not LDL directly that they are discussing, but PCSK9. Further in the text: "Among black subjects, 2.6% had nonsense mutations in PCSK9, which were associated with a 28% reduction in LDL cholesterol levels and with an 88% reduced risk of CHD events. The rate of PCSK9 sequence variations among white subjects was 3.2% and was associated with a 15% drop in LDL cholesterol and with a 47% reduced risk of CHD." I haven't yet found their original report on white subjects. However, some searching found this abstract on the black subjects: http://tinyurl.com/fvg24 http://content.nejm.org/cgi/content/abstract/354/12/1264?maxtoshow=&HITS=&hits=& RESULTFORMAT=1&author1=Hobbs&andorexacttitle=and&fulltext=PCSK9&andorexactfullte xt=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=1/1/2005&resourcetype=HW CIT Sequence Variations in PCSK9, Low LDL, and Protection against Coronary Heart Disease Jonathan C. Cohen, Ph.D., Eric Boerwinkle, Ph.D., Thomas H. Mosley, Jr., Ph.D., and Helen H. Hobbs, M.D. "Methods We compared the incidence of CHD (myocardial infarction, fatal CHD, or coronary revascularization) over a 15-year interval in the Atherosclerosis Risk in Communities study according to the presence or absence of sequence variants in the proprotein convertase subtilisin/kexin type 9 serine protease gene (PCSK9) that are associated with reduced plasma levels of LDL cholesterol." The abstract does not make it clear what the relationship (or "association") is between PCSK9 and LDL, nor does it give any detail on whether they then go into detail of that relationship with the various LDL particles variations which may be related to, say, a variation in the trigs/HDL ratio. Maybe someone here has access to the NEJM full version. I'll not get too worried about my LDL yet based on this. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg  SignatureEverything in Moderation - Except Laughter. > So, actually, it's not LDL directly that they are > discussing, but PCSK9. NICE CATCH!!!!! Unfortunately, because 101% of doctors will never look at the information you followed up on, it will become one more piece of "evidence" the statin companies will use to convince them that everyone has to drive down LDL to levels ONLY attainable with their drug. Thank GOD I was able to get the genetic test showing I have the advantageous LDL gene! --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > Thank GOD I was able to get the genetic test showing I have the > advantageous LDL gene! What exactly is the advantageous LDL gene & how do you test for it? >> Thank GOD I was able to get the genetic test showing I have the >> advantageous LDL gene! > > What exactly is the advantageous LDL gene & how do you > test for it? This is a gene which makes for very large, fluffy LDL which was found to be associated with longevity in a study conducted by researchers from Albert Einstein School of Medicine about 5 years ago. It was discussed in the New York Times when it was published. I don't think you can get tested for it. I got the test because I was included in that study because my 95 year old dad was a participant and their study design included relatives by blood and marriage (to sort out those genetically same and different). After the study was published, I contacted the researcher and she told me that I did indeed have the "longevity" gene. This was a relief as my typical total cholesterol reading is 308 and I am always getting yelled at by doctors about it. Only last year after my dad died at age 100 did my brother find his cholesterol tests from 40 years ago and discover that his total cholesterol back then was 340! But since I also have diabetes, and high blood sugars are capable of killing you even more than high cholesterol, I know that unless I control the blood sugars the "longevity gene" isn't going to do much for me. A couple of my dad's slim and active brothers died in their 60s from first heart attacks. My dad ate a very stringent diet which apparently controlled his blood sugar. They didn't. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control Jenny: Take a look at www.cbn.com/health/naturalhealth/drsears_heartattack.asp he says that the "fluffy type ldl" is better than small dense ldl but nothing more than that. Larry > >> Thank GOD I was able to get the genetic test showing I have the > >> advantageous LDL gene! [quoted text clipped - 32 lines] > http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood > Sugar Under Control > Jenny: Take a look at > www.cbn.com/health/naturalhealth/drsears_heartattack.asp > he says that the "fluffy type ldl" is better than small dense ldl but > nothing more than that. For crap's sake, Larry, that's not a scientific reference. Susan Susan/Jenny: His article certainly refers to excellent research which you can "google". No where will you find that LDLs higher than say 180 is ever a good thing. Regardless of particle size. Larry > x-no-archive: yes > [quoted text clipped - 6 lines] > > Susan > Susan/Jenny: His article certainly refers to excellent research which > you can "google". No where will you find that LDLs higher than say 180 > is ever a good thing. Regardless of particle size. Larry, he's selling diet books and prepared foods with a marketing plan that depends on making you believe that lowering LDL is critical. I'm not against lowering it by safe and effective means, but I also know that particle size and lipid ratios matter more than raw scores. Have you read Jenny's citations? Here's one more, demonstrating that LDL is a poor predictor of risk; I have the PDF if you'd like the full text: Ann Epidemiol. 2005 May;15(5):405-13. Related Articles, Links Click here to read A comparison of lipid variables as predictors of cardiovascular disease in the Asia Pacific region. Barzi F, Patel A, Woodward M, Lawes CM, Ohkubo T, Gu D, Lam TH, Ueshima H; Asia Pacific Cohort Studies Collaboration. The George Institute for International Health, University of Sydney, Camperdown, NSW 2050, Australia. fbarzi@thegeorgeinstitute.org PURPOSE: Many guidelines advocate measurement of total or low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglycerides (TG) to determine treatment recommendations for preventing coronary heart disease (CHD) and cardiovascular disease (CVD). This analysis is a comparison of lipid variables as predictors of cardiovascular disease. METHODS: Hazard ratios for coronary and cardiovascular deaths by fourths of total cholesterol (TC), LDL, HDL, TG, non-HDL, TC/HDL, and TG/HDL values, and for a one standard deviation change in these variables, were derived in an individual participant data meta-analysis of 32 cohort studies conducted in the Asia-Pacific region. The predictive value of each lipid variable was assessed using the likelihood ratio statistic. RESULTS: Adjusting for confounders and regression dilution, each lipid variable had a positive (negative for HDL) log-linear association with fatal CHD and CVD. Individuals in the highest fourth of each lipid variable had approximately twice the risk of CHD compared with those with lowest levels. *****TG and HDL were each better predictors of CHD and CVD risk compared with TC alone, with test statistics similar to TC/HDL and TG/HDL ratios. Calculated LDL was a relatively poor predictor.***** CONCLUSIONS: While LDL reduction remains the main target of intervention for lipid-lowering, these data support the potential use of TG or lipid ratios for CHD risk prediction. PMID: 15840555 [PubMed - indexed for MEDLINE] > Jenny: Take a look at > www.cbn.com/health/naturalhealth/drsears_heartattack.asp > he says that the "fluffy type ldl" is better than small dense ldl but > nothing more than that. Barry Sears is a diet book author . Not a medical authority. Here's an excellent article that explains the findings of the study I was in quite a lot of detail. http://www.seniorjournal.com/NEWS/SeniorStats/3-10-15livelonger.htm Here is the Journal of the American Medical Association (JAMA) research paper: http://jama.ama-assn.org/cgi/content/abstract/290/15/2030 --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control Jenny: Thanks for the references. I note that absolute LDL levels are not referred to but rather the proportion of large LDL particle size. Can we still conclude that " very high" LDL levels are not good regardless.? I think so. It also can be concluded that a high proportion of low density LDL particles just means that necessarily a smaller amount of the destructive high density LDL particles are present hence a benefit. I don't see anywhere where fluffy LDL particules have an inherent benefit in the same way that HDLs have on good health. Larry >> Jenny: Take a look at >> www.cbn.com/health/naturalhealth/drsears_heartattack.asp >> he says that the "fluffy type ldl" is better than small dense ldl but >> nothing more than that. > > Barry Sears is a diet book author . Not a medical authority. Actually Sears is somewhat of a medical authority and more than a diet book author. He has a PHD in biochemistry and has conducted a few studies in diabetic patients. Some results have been published in his books. One of his books served as an introduction to biochemistry for me - The Anti-aging Zone. I paid $3.99 for it at Ollie's and it was well worth it. The language in his books is less technical than most scientific and health journals. On the other hand, he is promoting products that he sells, such as his books and highly refined fish oil. He admits that he and his brother tried to corner the borage oil market in Canada. He is out to make a buck. Frank |
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