#1237

PCSK9 inhibitors, for example, do not have a big influence on inflammation levels but still cause a reduction in events and regression in plaque.

2 Likes
#1238

I think I achieved good results in lowering cholesterol taking 5mg Ezetimibe, 5 mg atorvastatin daily in addition to a-cyclodextrine fiber.

Dec 2023/Sep 2024

Apo B. 109/66

Total chol 207/181

HDL 98/96

LDL 95/69

Triglycerides 72/ 60

Non HDL. 109/ 81

7 Likes
#1239

@LaraPo those are great results. Question, do you intend using Ezetimibe and atorvastatin now that you already got to the levels you desired? In other words does one need to take these meds in perpetuity to maintain such levels? and is there a risk of getting these levels too low if continually taking such drugs, or that is not possible?

1 Like
#1240

Those drugs only work while you take them. Within a few weeks of cessation your levels will go up to prior levels.

4 Likes
#1241

Great to know. thanks @Virilius, how about the rest of the question, can the levels drop too low?, or we are protected by evolution and there won’t be such a thing as too low.

#1242

I plan on continuing with these low doses to maintain or even improve (my hdl could be lower, as well as ApoB).

1 Like
#1243

I thought HDL the higher the better, NO, or you meant LDL?

#1244

The higher the better but too high is not good as well.

1 Like
#1245

Interesting, much to learn I guess lol. anyway, actually it’s right here on WebMD, clearly higher levels of HDL are pretty risky, didn’t know that.

Can High Levels of Good Cholesterol Be Bad for You? (webmd.com)

2 Likes
#1246

Not even drugs can bring you lower than 10-20mg/dL LDL-C which is thought of to be the safe lower limit.

2 Likes
#1247

Children up until they become teenagers will have an LDL of around 40. If all the children of the world do not suffer from low cholesterol issues, I don’t see why adults would. I am targeting LDL below 50.

Also, HDL is good up until it becomes higher than LDL. It can cause other health problems such as increased prostate cancer risks.

The best situation, IMHO, is to have LDL and HDL both low and as equal to each other as possible.

2 Likes
#1248

That U curve goes away when nutrition status and sometimes inflammation are taken into account. there are a few papers on that. I can try to find them again if people are interested.
Basically in the very low LDL cohort, there are some who reduce their LDL on purpose and that’s OK if they eat enough and are not inflamed. The majority of the other ones don’t have proper nutrition (anorexia, cachexia, elderly not eating enough, etc.) and hence can have a low LDL but are a very unhealthy group.

2 Likes
#1249

Alternatively a reduction in LDL exposure has that effect in the short term on events as shown in the RCT’s.

1 Like
#1250

Think LDL often is lower in people with cancer also

2 Likes
#1251

What is more telling is not life-long low LDL levels, but a sudden change or drop in LDL. That’s often the result of a disease process or body reaction to disease. There is this well-known theme patients with serious disease, where some biomarkers suddenly “improve”, LDL drops, inflammation markers are lower, the patient feels better etc. - and then the patient dies. That’s because often times, the body is fighting the disease, perhaps through increased inflammatory agents that are fighting some aspect of the disease and so on, and this puts a great deal of stress on the body, and the patient is suffering. But when the body gives up, all of a sudden, the patient feels better, there is no more struggle, except death is around the corner. Frequent theme: they were doing much better, but then they died! His LDL dropped, cholesterol got better, then he died!

Change is what’s concerning. If there is no obvious reason for the LDL to suddenly drop, alarm bells should go off. Of course I’m not talking about someone who cleaned up their diet or took other measures to lower LDL. I’m talking spontaneous change. That’s a problem. Life long low LDL, not a problem.

#1252

I’d love to read these papers! The latest Chinese paper adjusted many variables but not nutrition (calories eaten per day? diet “score”?):

image
image1384×860 137 KB

1 Like
#1253

Here is a Frontiers one. They adjusted for Controlled nutritional status (CONUT) and total bilirubin.
Paradoxical Association Between Baseline Apolipoprotein B and Prognosis in Coronary Artery Disease: A 36,460 Chinese Cohort Study

As you can see below, the Model 3 is only adjusted for malnutrition and is quite linear.
Interestingly the model 4 with nutrition and all the other covariates does not reach statistical significance for low ApoB but is even more linear.

image
image1920×1259 144 KB

Here are the Hazard Ratios

image
image2116×898 268 KB

4 Likes
#1254

Thanks. Not the greatest journal or research team but still interesting.

“Nutritional status was evaluated using the Controlled nutritional status (CONUT) scoring system. CONUT score is a comprehensive evaluation of serum albumin concentration, the total number of peripheral blood lymphocytes, and total cholesterol concentration.”

Score based on this paper: CONUT: a tool for controlling nutritional status. First validation in a hospital population - PubMed

But there’s total cholesterol in the nutrition score… The other Chinese paper was also adjusting for HDL so maybe that’s OK. If that’s the case then we should just adjust for albumin and lymphocytes in previous papers and see if the U-curve disappears.

2 Likes
#1255

Yes. From a mathematical point of view that’s probably what flattens the curve.
Cholesterol is useful. It’s mostly only ApoB that accumulates in the plaques when other factors are present so it makes sense that low total cholesterol which is also correlated with low ApoB is the real cause of an increased ACM.

More simply: low or very low ApoB (LDL) is good. Low of very low total cholesterol is bad.

BTW that explains all those U shape curves as those 2 are correlated: In the low end low TC is the dominant factor while in the high end LDL is the dominant factor.

The actionable information is that very low LDL is good as long as TC and especially HDL are not low.

#1256

i like your logic, i target 50 to 70 for much the same reason. The MR and RCTs do support down to 50 as you say. But they don’t convincingly support much below that.

I found this recent optispan podcast interesting. Apologies if it’s been covered elsewhere, but from the 1.03 mark they discussed blood lipids and a more nuanced view of what’s actually going on, and why we may be falsely thinking lower the better.

2 Likes