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What the latest science on cholesterol levels?
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Hello,

I had my yearly blood tests and my cholesterol is high and the doc want me on meds. I'm 47 and active, hence the reason why I hang out here. Dad died at 57 from heart disease. He smoked, drank and didn't exercise one bit. I can't remember seeing dad eat a piece of fruit or a vegetable that wasn't fried.

My numbers seem lopsided > My bad cholesterol is really bad but my good cholesterol is really good and my ratio is really good.

I remember reading that people that are active and eat relativity ok, shouldn't think about medications for cholesterol until the total number is over 300. Disclaimer: My diet consist of a lot of red meat and fried foods!

I'm coming here for advice because I believe that the medical field doesn't take into consideration that very active people are very different from the normal/average sedentary population in today's world.

So what's the latest science / word??

Here are my results:

Cholesterol 264 mg/dL


Triglyceride 59 mg/dL


HDLD 76 mg/dL


LDL 191 mg/dL


Calc VLDL 11.8 mg/dL


Chol/HDL 3.5 RATIO


Non-HDL 188 mg/dL

Last edited by: gall1972: Apr 8, 19 13:33
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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Even if you are active, maybe you could eat more fiber or drink more water.

https://www.strava.com/...tes/zachary_mckinney
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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gall1972 wrote:
Hello,

I had my yearly blood tests and my cholesterol is high and the doc want me on meds. I'm 47 and active, hence the reason why I hang out here. Dad died at 57 from heart disease. He smoked, drank and didn't exercise one bit. I can't remember seeing dad eat a piece of fruit or a vegetable that wasn't fried.

My numbers seem lopsided > My bad cholesterol is really bad but my good cholesterol is really good and my ratio is really good.

I remember reading that people that are active and eat relativity ok, shouldn't think about medications for cholesterol until the total number is over 300. Disclaimer: My diet consist of a lot of red meat and fried foods!

I'm coming here for advice because I believe that the medical field doesn't take into consideration that very active people are very different from the normal/average sedentary population in today's world.

So what's the latest science / word??

Here are my results:

Cholesterol 264 mg/dL


Triglyceride 59 mg/dL


HDLD 76 mg/dL


LDL 191 mg/dL


Calc VLDL 11.8 mg/dL


Chol/HDL 3.5 RATIO


Non-HDL 188 mg/dL

the fried foods will really get you, depending on how deep fried you like it

I love French fries - I have ordered 3x Large Fries at Chick Fil A ... mmmmmmm 2x sandwiches with 2x cookies and cream milkshakes and a fruit salad - lolol I was hungry

https://www.strava.com/...tes/zachary_mckinney
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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With a good ratio, and a moderately high cholesterol level you should not be on medicine. You can try some diet changes but, if you are healthy and not fat then I wouldn't worry. You could go get another test and it might clock at 200. Yes, it can change that much day to day. With a good ration, I've never seen anyone be put on medicine. That's the last thing you want.
Last edited by: NealH: Apr 8, 19 19:03
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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gall1972 wrote:

Cholesterol 264 mg/dL
Triglyceride 59 mg/dL
HDLD 76 mg/dL
LDL 191 mg/dL
Calc VLDL 11.8 mg/dL
Chol/HDL 3.5 RATIO
Non-HDL 188 mg/dL


The reason I get active on these boards is misinformation. It drives me absolutely bonkers. Well, there is some in this thread, well meaning, but can mislead you. As always, talk to your doctor (and you can even print this and discuss with him) about risks/benefits of drug Rx for your very elevated cholesterol.

I don't have time to manage or push people to do the right thing every time I read these things, and honestly, I'd like to not have to do this... One of the statin benefit groups is anyone with an LDL >190-period. Do great at the diet/exercise/weight loss and get the numbers down, throw them into a risk calculator; get a coronary ct calcium score-do other stuff to risk stratify and maybe lower/stop the meds. But, that is HIGH RISK. Like 7-8%/year risk of an MI/death PER YEAR. Drug Rx can lower the risk to ~1%/yr.


In this day and age, evidence based medicine/cardiology defines those numbers as requiring drug Rx. It equals a genetic abnormality of very high bad lipids.


Statin Rx is advised. Talk to your doctor.

I've brought this up before (many times)-check this thread-read post #17 if you want to cut to the chase.

https://forum.slowtwitch.com/...st=last-6643505#last

I'll make it easier:

https://www.acc.org/~/media/Non-Clinical/Migration-Content/Media-Center/Infographics/Blood%20Cholesterol/I13116_INFOGRAPHIC_Lipids_Guidelines_PDF.pdf?la=en


(*I've got to stop reading ST...this is so time consuming...but I hope a few lives were changed along the way, I do hope...)
Last edited by: dtoce: Apr 8, 19 17:46
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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My numbers were a little worse than yours. Similar, but let's say 10 or 15% higher across the board. I'm 61. Both my general doc and cardio guy are late 50's/early 60's endurance athletes, just like you and me. They both recommended a low dose statin - 10 mg generic Crestor daily. I resisted, but decided to give it a try. It's been six months now. My results to date:

Total cholesterol dropped over 100 points with HDL (the good one) still high.

Zero side effects - muscle soreness or other.

When I go to the pharmacy, the cost is zero. Insurance picks up 100%.

I could have a cardiac event tomorrow obviously, but I think we can agree my n=1 statin experience to date has been a big win.

Ben
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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For the love of God, listen to your doctor and not people on a message board. Take the meds if he/she says you should take the meds.
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Re: What the latest science on cholesterol levels? [benhawn] [ In reply to ]
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benhawn wrote:
My numbers were a little worse than yours. Similar, but let's say 10 or 15% higher across the board. I'm 61. Both my general doc and cardio guy are late 50's/early 60's endurance athletes, just like you and me. They both recommended a low dose statin - 10 mg generic Crestor daily. I resisted, but decided to give it a try. It's been six months now. My results to date:

Total cholesterol dropped over 100 points with HDL (the good one) still high.

Zero side effects - muscle soreness or other.

When I go to the pharmacy, the cost is zero. Insurance picks up 100%.

I could have a cardiac event tomorrow obviously, but I think we can agree my n=1 statin experience to date has been a big win.

Ben

I'm glad your experience has been one of 'no side effects' but honestly in cardiology, we hope for low cardiac risk AND low side effects.
The risk of an event is MUCH LOWER with a lower LDL. "Trust in me" (*said Kaa), but I believe in evidence based medicine/cardiology.

Statin Rx is recommended for any LDL >190=genetic, familial hyperlipidemia. Get treated and lower the risk (By NCEP data from 7+%>1%) with statin Rx.
Anyone can have a cardiac event tomorrow, but the RISK is lower with best medical treatment (AKA-guideline directed medical Rx).

See your doctor...please...

I haven't stayed at a Holiday Inn Express, but I AM a doctor...a board certified cardiologist FTR
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Re: What the latest science on cholesterol levels? [dtoce] [ In reply to ]
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what if your numbers are high, but coronary(or whatever it is called) scan shows zero blockage? just curious if thought process stays the same
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Re: What the latest science on cholesterol levels? [jeffp] [ In reply to ]
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jeffp wrote:
what if your numbers are high, but coronary(or whatever it is called) scan shows zero blockage? just curious if thought process stays the same

great question! If no plaque has built up yet, by CT scan, there may be risks (based on family history of premature CAD, other RF for CAD) but risk is generally very low. No Rx with ASA or statin needed. Repeat CT scan advised in 3-5 years-data still forthcoming.

And, as always, discuss risk/benefit of the plan with your MD.

(of note, getting my own CT coronary calcium score next month (to be paid out of pocket as insurers will not cover it)-after LC world championships-I don't want to know before that...)
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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Given your test and family history, you are not ok.

I think you have to change your diet immediately and get tested again in a few months.
If there is not improvement get on the meds and then if you can't deal with the side effects, go from there. You can not out run gentitics or articles and opinions that tell you that you are ok and don't endorse changing now. This opinion says opposite.
I know this from a good friends experience.

Hope you can get it under control and wish you the best.

Rob
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Re: What the latest science on cholesterol levels? [dtoce] [ In reply to ]
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thanks, I am not sure what test I had back in Aug before mitral valve repair, but doc handed me a photo and said everything was clear(no blockages) was part of heart cath a couple weeks before surgery where they wanted to check all the arteries before the surgery(then amiodarone really jacked everything and still waiting for that to normalize, 5.5 months after stopping it, I hope within another 6 months)
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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Eat more plants.

Be Uncommon
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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gall1972 wrote:
Hello,

I had my yearly blood tests and my cholesterol is high and the doc want me on meds. I'm 47 and active, hence the reason why I hang out here. Dad died at 57 from heart disease. He smoked, drank and didn't exercise one bit. I can't remember seeing dad eat a piece of fruit or a vegetable that wasn't fried.

My numbers seem lopsided > My bad cholesterol is really bad but my good cholesterol is really good and my ratio is really good.

I remember reading that people that are active and eat relativity ok, shouldn't think about medications for cholesterol until the total number is over 300. Disclaimer: My diet consist of a lot of red meat and fried foods!

I'm coming here for advice because I believe that the medical field doesn't take into consideration that very active people are very different from the normal/average sedentary population in today's world.

So what's the latest science / word??

Here are my results:

Cholesterol 264 mg/dL


Triglyceride 59 mg/dL


HDLD 76 mg/dL


LDL 191 mg/dL


Calc VLDL 11.8 mg/dL


Chol/HDL 3.5 RATIO


Non-HDL 188 mg/dL


total cholesterol number is without any meaning by itself
Chol/HDL ratio is the only one that counts. you have 3.5 which is well below the risk threshold of 5 (for men, 4.5 for women)

my total chol is increasing every year but the ratio follows so no arm at all
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Re: What the latest science on cholesterol levels? [dtoce] [ In reply to ]
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Thanks for your thoughtful response. I do appreciate it.

I *am* seeing my doctor – both my primary care doc and the cardiologist. After seeing the results of 10 mg Crestor for a few months, my cardio was pleased and wants to see me in one year. I exercise daily and am asymptomatic. 10X IM finisher and long time exercise addict.

Jan. 2018:
HDL 62
LDL 186
Total cholest. 272
Trigly. 117

One year later, after about three months on 10 mg Crestor:

Jan. 2019:
HDL 56
LDL 103
Total cholest. 176
Trigly. 81

dtoce wrote:
benhawn wrote:
My numbers were a little worse than yours. Similar, but let's say 10 or 15% higher across the board. I'm 61. Both my general doc and cardio guy are late 50's/early 60's endurance athletes, just like you and me. They both recommended a low dose statin - 10 mg generic Crestor daily. I resisted, but decided to give it a try. It's been six months now. My results to date:

Total cholesterol dropped over 100 points with HDL (the good one) still high.

Zero side effects - muscle soreness or other.

When I go to the pharmacy, the cost is zero. Insurance picks up 100%.

I could have a cardiac event tomorrow obviously, but I think we can agree my n=1 statin experience to date has been a big win.

Ben


I'm glad your experience has been one of 'no side effects' but honestly in cardiology, we hope for low cardiac risk AND low side effects.
The risk of an event is MUCH LOWER with a lower LDL. "Trust in me" (*said Kaa), but I believe in evidence based medicine/cardiology.

Statin Rx is recommended for any LDL >190=genetic, familial hyperlipidemia. Get treated and lower the risk (By NCEP data from 7+%>1%) with statin Rx.
Anyone can have a cardiac event tomorrow, but the RISK is lower with best medical treatment (AKA-guideline directed medical Rx).

See your doctor...please...

I haven't stayed at a Holiday Inn Express, but I AM a doctor...a board certified cardiologist FTR
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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Don't get your medical advice from Slowtwitch. Get it from Pinterest like every body else.

https://www.youtube.com/watch?v=PQpQOLnzQ6E
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Re: What the latest science on cholesterol levels? [benhawn] [ In reply to ]
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Why post if you know you are eating crap. Lets say red meat is grey area (trying to avoid diet wars and there are studies that conflict both parties). But fried foods, have artificial transfats, proven to cause heart disease and cancer
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Re: What the latest science on cholesterol levels? [dtoce] [ In reply to ]
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dtoce wrote:
jeffp wrote:
what if your numbers are high, but coronary(or whatever it is called) scan shows zero blockage? just curious if thought process stays the same


great question! If no plaque has built up yet, by CT scan, there may be risks (based on family history of premature CAD, other RF for CAD) but risk is generally very low. No Rx with ASA or statin needed. Repeat CT scan advised in 3-5 years-data still forthcoming.

And, as always, discuss risk/benefit of the plan with your MD.

(of note, getting my own CT coronary calcium score next month (to be paid out of pocket as insurers will not cover it)-after LC world championships-I don't want to know before that...)

Shouldn't any recommendation of statins come with a required CT scan? Otherwise it's just a crap shoot as to if you are helping anything early enough? Maybe he needs a stent ASAP? It's the clogs that matter, and the cholesterol levels a secondary indicator.
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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My numbers are eerily similar to yours, including age (I'm 46). I had the same questions and asked for a second opinion, from a long-distance triathlete friend of mine who is a DOCTOR. She was adamant that I take the meds. After almost a year I can say that the only side-effect of the meds (Lipitor) is that my cholesterol is down, as is my risk of dying of a stroke or heart attack.
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Re: What the latest science on cholesterol levels? [gall1972] [ In reply to ]
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You are what you eat. If your diet consist a majority of red meat and fried food, you already know what you should do.. Do you have the drive to actually change is up to you, but I think you already know. If you want others to tell you to do what you've been doing is fine, then you came to the right spot. If you actually want to change, start with what you put inside your body. Doesn't make sense that one will eat tons of inflammatory foods but doesn't want to take the pills that come with it. Stop eating the inflammatory foods, you probably wont need the pill and you'll see a change.
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Re: What the latest science on cholesterol levels? [dtoce] [ In reply to ]
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dtoce wrote:


Statin Rx is recommended for any LDL >190=genetic, familial hyperlipidemia. Get treated and lower the risk (By NCEP data from 7+%>1%) with statin Rx.
Anyone can have a cardiac event tomorrow, but the RISK is lower with best medical treatment (AKA-guideline directed medical Rx).


My family (father tree) has high numbers, but no cardiac events has ever happened.
I'm at 33, 137mg/dL LDL (it varies between 130 and 160), 50 mg/dL HDL (40-60 range),190mg/dL Total (190-230 range) and Trig at 80mg/dL.
I check it out 2 times per year but I never go to a cardiologist.

I eat well. Really well.

Should I worry or I'm fine (at least number wise) for now?
Last edited by: binhopires: Apr 9, 19 12:08
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Re: What the latest science on cholesterol levels? [binhopires] [ In reply to ]
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binhopires wrote:
dtoce wrote:


Statin Rx is recommended for any LDL >190=genetic, familial hyperlipidemia. Get treated and lower the risk (By NCEP data from 7+%>1%) with statin Rx.
Anyone can have a cardiac event tomorrow, but the RISK is lower with best medical treatment (AKA-guideline directed medical Rx).


My family (father tree) has high numbers, but no cardiac events has ever happened.
I'm at 33, 137mg/dL LDL (it varies between 130 and 160), 50 mg/dL HDL (40-60 range),190mg/dL Total (190-230 range) and Trig at 80mg/dL.
I check it out 2 times per year but I never go to a cardiologist.

I eat well. Really well.

Should I worry or I'm fine (at least number wise) for now?

What makes you say you eat well? HDL is a bit low
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Re: What the latest science on cholesterol levels? [synthetic] [ In reply to ]
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synthetic wrote:
binhopires wrote:
dtoce wrote:


Statin Rx is recommended for any LDL >190=genetic, familial hyperlipidemia. Get treated and lower the risk (By NCEP data from 7+%>1%) with statin Rx.
Anyone can have a cardiac event tomorrow, but the RISK is lower with best medical treatment (AKA-guideline directed medical Rx).


My family (father tree) has high numbers, but no cardiac events has ever happened.
I'm at 33, 137mg/dL LDL (it varies between 130 and 160), 50 mg/dL HDL (40-60 range),190mg/dL Total (190-230 range) and Trig at 80mg/dL.
I check it out 2 times per year but I never go to a cardiologist.

I eat well. Really well.

Should I worry or I'm fine (at least number wise) for now?


What makes you say you eat well? HDL is a bit low

I eat a lotof plants, whole grains, fish, good fat, lean meat and so on. I follow the guidelines prescribed by a good sports nutritionist.
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Re: What the latest science on cholesterol levels? [synthetic] [ In reply to ]
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Disclosure: I am NOT a doctor

Don't take my word on the following. I am providing merely as information for you to dig deeper into this subject.

I read quite a bit on nutrition, exercise, health, etc... My impression is that too often we still rely on eminence based medicine rather than evidence based. Also, there are far too many poorly done epidemiology based studies. Therefore, one must be skeptical, get informed, and ask the right questions. In my experience doctors are often too quick to recommend a medication to treat the symptom, rather than correct the root cause, which more often than not is due to lifestyle choices. Also, with respect to guidelines, they can change at any time (for example the ADA recently reversed itself on low carb diets).

As to cholesterol and the needs for statins, here are things I've read/heard that I find interesting. When looking at cholesterol, you need to look at the triad, LDL, HDL, and triglycerides. Goal should be to get HDL and triglycerides as close as possible to a 1:1 ratio. For example, HDL of 50 and triglycerides of 75 is better than HDL of 40 and triglycerides of 125. If those numbers are good, it's not clear to me what an acceptable "LDL" number is/should be. Diet could be very important here (is your body fat adapted, i.e. can be fat for fuel, or dependent on carbohydrates).

I have recently started following a guy on Twitter, Dave Feldman (@DaveKeto), an engineer, who is doing some interesting work in this area. You could easily find a podcast he is on. If I recall correctly, he has seen his LDL change 100 points in a very short period of time.

I've also heard references to a recent Stanford metastudy on statins that shows they do NOT reduce all cause mortality. I don't have a link to it so I still have some skepticism. There may be other side effects related to statins that could be of concern (increased risk of T2 diabetes, and subsequently Alzheimers).

Diet and exercise can play a huge factor in this. Back when I was doing half ironman's, I was on a high carb diet. I started to see things I didn't like. I have shifted to more of a low/no carb diet. Also shifted from long and steady/slow, to more short period of high intensity. Seen improvements in a number of areas including blood work.

Again, please be cautious in how you use what I have said. I could have it completely wrong (but I don't think so). You're doing the right thing in asking the question. There is lots of information out there, both good and bad. Be your own advocate. Learn about the topic. Get a second opinion. Keep asking questions. Challenge your doctors with good questions (difficult when you only get 10 -15 minutes. I once offered my doctor $100 cash to spend 15 additional minutes with me - he did but didn't take the money). Most importantly I do believe you do not have to be on medication long term. There are lifestyle choices you can make so you don't need the meds.

Good luck. (Well into middle age and medication free, which I am told is unusual every time I go to the doctor).
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