Why not just get "perfect" lipids and call it a day?

5. September 2006 William Davis (0)
What if you achieved the Track Your Plaque lipid targets: LDL cholesterol 60 mg/dl, HDL 60 mg/dl, and triglycerides 60 mg/dl?

After all, these are pretty stringent standards. Compared to national guidelines (the ATP-III Guidelines of the National Cholesterol Educational Panel), the Track Your Plaque 60-60-60 goals are laughably ambitious. There's a lot of wisdom hidden in those numbers. The triglyceride level of 60, for instance, is a level at which triglycerides become essentially unavailable for formation of triglyceride-containing lipoprotein particles such as small LDL and VLDL.

If you get to the 60-60-60 target, isn't that good enough? What if you just held your values there and went about your business? Will coronary plaque stop growing and will your CT heart scan score stop increasing?

Sometimes it will. But, unfortunately, many times it will not. The experience generated through clinical trials bear this out. Studies like the St. Francis Heart Study and the BELLES Trial both showed that just reducing LDL cholesterol is insufficient to stop plaque growth. Beyond the Track Your Plaque experience, there's no clinical trial experience that shows whether the 60-60-60 approach does any better.

In our experience, achieving 60-60-60 is indeed better than just reducing LDL. That makes sense. Just raising HDL from the average of 42 mg/dl for a male, 52 mg/dl for a woman adds advantage. Compound this with triglyceride reduction from the plaque-creating equation, and you've doubled success.

But there's even more. What if you had hidden patterns not revealed by conventional lipids? How about lipoprotein(a)? Small LDL? Postprandial (after-eating) abnormalities? Hypertensive effects (more common than you think)!

In 2006, stopping the increase in your heart scan score is, for most of us, not just a matter of taking Lipitor or its equivalent and sitting back. For nearly all of us, stopping the progression of your score is a multi-faceted effort.
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Which is better?

Which is better?

4. October 2007 William Davis (12)
If you have the common pattern of high LDL particle number (NMR) with small LDL--a pattern highly related to coronary plaque--which is better:




Lipitor or a combination of fish oil, vitamin D, and elimination of wheat?


Lipitor quite effectively reduces LDL particle number, usually on the order of 40% or so. Effect on LDL particle size: None. Side-effects: plenty, including muscle aches (inevitable in my experience, not the ridiculous 2% they claim) and occasionally mental effects such as impaired short-term memory.

Lipitor does seem to exert a modest effect on reduction of C-reactive protein, around 30%. It also reduces cardiovascular events by 30%.



A combination of fish oil, vitamin D, and elimination of wheat:

Reduces LDL particle number commonly by a similar 40% (though variable, depending on body weight). There is substantial improvement in LDL particle size, a large drop in C-reactive protein, often >50%, a 30% or more reduction in cardiovacular events.



On this combination, however, you also:

--Lose weight, often substantially.

--Improve bone health, esp. osteoporosis and arthritis.

--Reduce cancer risk from the vit D supplementation.

--Reduce risk of stroke.

--Reduce postprandial (after-eating) abnormalities like intermediate-density lipoprotein.

--Reduce winter blues.

--Experience more energy.

--Obtain increased clarity of thought (from elimination of wheat).

--Reduce blood pressure.


Oh, and there's no muscle aches.
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Comments (12) -

  • A new reader

    10/4/2007 3:43:00 PM |

    What's your beef with wheat?

  • Anonymous

    10/4/2007 3:51:00 PM |

    I married a depressive. Passion generated seritonin, so she was fine. She went off her pills.

    Then, she was prescribed a statin.

    The normal physiological process in "falling in love" moves from seritonin to frendship chemicals and then nothing at which point you have hopefully bound yourselves up in obligations, respect, and friendship.

    Well, statins decrease testosterone in women, which supports the seritonin production, so if that women is a depressive, the passion is terminated and you never get to friendship.

    No woman should ever be prescribed a statin. Sure they might have better cardiac health, but their quality of life will sink--if they survive the depression and suicides.

    Not fun.

    Never sign an ARM. Never take a statin.

  • Dr. Davis

    10/4/2007 3:55:00 PM |

    Please see my numerous prior posts on this question. Wheat products are among the most heart disease and diabetes causing foods I  know.

  • Anonymous

    10/4/2007 3:57:00 PM |

    Here's an even better idea, combine both tratments and lower your risk even further !!! In MOST people statins are very and VERY helpful.

  • Dr. Davis

    10/4/2007 4:22:00 PM |

    There are times when the Lipitor becomes superfluous.

  • WCCAguy

    10/4/2007 5:23:00 PM |

    Hi Dr. Davis,

    Because I know my risk is high due to previous cardiac events, I didn't stop taking Lipitor 80 and Zetia 10 before getting a Berkeley Heart Lab (BHL) blood draw earlier in the week.

    My thought was that I could assess my BHL numbers, begin ramping up on the TYP program recommendations this week and next, and then draw down my Lipitor dose sometime later over time (perhaps never to 0) as I feel more confident that I'm not putting myself at increased risk in doing so.

    Does that make sense as a general strategy for transitioning to TYP?  Any other general thoughts about this?

  • Anonymous

    10/4/2007 7:57:00 PM |

    I've come to think of wheat as a "sugar equivalent"  and it makes no difference if it's whole wheat or not.

  • Dr. Davis

    10/4/2007 9:06:00 PM |

    Yes, absolutely. A stepwise approach to converting to a program with the least amount of drugs but maximum benefit is usually best.

  • Anonymous

    10/6/2007 5:22:00 PM |

    Actually I would think the best combination would be Zocor and Slo niacin. According to the Hats Trial this combination reduced the risk of heart attack by 90% versus placebo. In this case the niacin would probably be the best thing for the small LDL particuls. Add your vitamin D and an aspirin a day and you have virtually no chance of heart disease if you eat well and excercise.

  • Michelle C

    10/26/2007 1:50:00 AM |

    Dr. Davis,

    Could the short term memory problems associated with a statin be mistaken for the beginnings of memory problems associated with aging.  My grandmother is 84, has taken a statin for years, but in the last few has been having problems with her short term memory.  

    I asked her internist about it, but his comment was that the research was controversial and had her keeping taking the lipitor.

    She also is slipping toward hypothyroidism which may have to be treated soon.

    Thanks!

  • Dr. Davis

    10/26/2007 1:59:00 AM |

    Hi, Michelle--

    To my knowledge, the only way to connect Lipitor with memory deficits is to stop the drug for about 4 weeks. It takes that long to see the effects recede if it is indeed due to the drug. However, you will need to discuss this with your grandmother's doctor first.

  • Anonymous

    8/10/2010 12:27:32 AM |

    "muscle aches (inevitable in my experience)"

    I took statins for about 20 years until a couple of weeks ago when I decided to stop.  I didn't experience muscle aches.

    --Lub Dub (my TYP membership name)

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