About that cholesterol

So, in the context of the cardiometabolic health thread, here’s an interesting tidbit that coincidentally drifted across my radar screen. Full disclosure, Peter Attia’s articles like this are free teasers to invite you to be a paid subscriber to his blog/podcast series. Have to say, there’s enough free stuff for the casual reader to get the gist (which isn’t true of, say, the WSJ, NYT etc) so a subscription isn’t really necessary unless you like to do a “deep dive” into the details (which I do) Anyway, I credit Attia and his focus on cardiometabolic health with discovering that I’m not, in fact, one of the 7%

For as long as I’ve taken notice of my lipid profile, my slightly elevated LDL-C (toggling around the low 100s …slightly sub-optimal)has never raised concern given my supposedly compensating high HDL-C, low VLDL, triglycerides and overall Righteous Lifestyle Choices. I’ve read of trends towards more aggressive lowering of LDL so, along with the Usual Suspects, I asked my primary care physician for insulin resistance check (not wanting to wait for that blood glucose and HbA1c to start trending upwards)and Apo-b lipoprotein measurement…just in case. She suggested a Coronary Artery Calcium scan if I was really concerned.

Well, the HOMA-IR was low…showing excellent insulin sensitivity, the Apo-b on the high side (but not stratospheric) but the CAC WAS high…showing evidence of longstanding atherosclerotic coronary artery disease. Who’da thunk. On the follow up last week to check my low dose Lipitor is working and not messing up with my liver enzymes, doctor admitted that, like previous physicians…and me, to be fair…she’d been inclined to disregard that LDL given my obviously healthy lifestyle choices. I guess the message is, don’t be too complacent when a family history raises a red flag.



…compensating high HDL-C…

A few recent studies have shown that a high HDL over 80, IIRC, can be an indicator/cause of cardiovascular disease too. There is a U shaped risk curve, below 40 and above 80, with optimal being in the between.

Don’t think they have found out why a high HDL can be an indicator.

I had a coronary artery calcium scan about a year ago. Two big things to keep in mind. One, only hardened plaque will show up on the scan. You could have plenty of soft plaque which could cause a critical stenosis before hardening. Two, haven’t seen any long term studies comparing it to the gold standard of cardiac cath. Definitely less invasive and takes maybe 5 minutes both are good things.




I had a scan done. My reading was 163. The reading showed a scattering. No blockage.

I lost 50 lbs. My numbers vastly improved. Really good bp readings no med. Very good cholesterol numbers. Very good glucose and A1C numbers.

But I stayed on a bit of statin and metformin to reduce my risks of coronary disease. This MIGHT be a time of healing for my arteries.

I have taken up long stretching routines and not HIIT every other day and two mile walks. My health continues to improve.

I am getting better with age.

A few recent studies have shown that a high HDL over 80, IIRC can be an indicator/cause of disease too…

Yep, I’ve read that. I think it can be applied to quite a few precriptive things when looking at dose-response. HDL, BP reduction, etc …even exercise. A little being good, a bit more even better up to a point of diminishing returns or, even worse, a rise in morbidity/mortality. The so called “reverse J curve”

Don’t think they have found out why a high HDL can be an indicator

I think that oftentimes high HDL goes alongside elevated non-HDL C. Not just that, it suffers from the Health Halo that goes along with the “good” cholesterol moniker. To the extent that it’s not unheard of for folk to lead up on any and every supplement purported to raise this good cholesterol…and ignore their physician’s recommended strategy to lower their LDL. Statistics skewed by the psychology of cholesterol denialism rather than the physiology of high cholesterol. Maybe.

One, only hardened plaque will show up on the scan…

Yep. The best analogy I’ve heard (from Peter Attia, as it happens) is that a non-zero CAC scan score is like acne scars. The body’s response/scar tissue from past disease. No way does it tell you if that disease is ongoing in the way that pimples, pustules and boils do with acne. I’m working on the notion that if what has caused the issue in the first place is still ongoing…excessive amounts of that Apo-b particle…the plaques are still forming. THAT’S what I’m aiming to stop.

I’ve stayed ahead of the game so far as I’m totally symptom free…even with higher intensity exercise at high altitude…but I don’t feel inclined to trust to that now I’m coming up to 70.

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