Transcription
I'm a doctor, and I haven't prescribed a statin to lower LDL cholesterol in over eight years. But why isn't LDL the greatest risk factor for heart disease? Well, when you look into the data, that's actually not the case. LDL cholesterol is so far down the list of risk factors that it's one of the last things that I look at in a patient's chart. You've been lied to about LDL cholesterol. I'm going to break this down once and for all with three main parts. By the end of this, you will have a clear idea of the risks associated with statins, the real number one risk factor for heart disease, and what LDL cholesterol actually does in your body.
Starting with LDL cholesterol is not bad. For decades, doctors have educated patients about cholesterol using third-grade English. They told you that HDL cholesterol is known as good cholesterol and LDL cholesterol is bad cholesterol. And that's all you need to know about it. This oversimplification hides the real truth.
When we talk about cholesterol, we are really talking about things called lipoproteins. These lipoproteins serve a very important role in your body by packaging the fat you made in the liver and sending it out as energy to your cells. We give these lipoproteins a different name depending on how big they are. A lipoprotein starts its life cycle as a chylomicron. It's the biggest and fluffiest lipoprotein. And within an hour, it shrinks by donating a bunch of cholesterol and triglycerides. And then we call it a very low-density lipoprotein, VLDL. The cycle repeats with VLDL. It donates a bunch of energy and shrinks again. And now we call it an intermediate-density lipoprotein. Yeah, it gets worse. Then we get what everybody demonizes, which is a low-density lipoprotein, or LDL, the "bad" cholesterol. But remember, its only purpose is to provide cells with energy. And notice that this is the same lipoprotein that we would have called a chylomicron a few hours ago. It's just smaller and denser now.
So, how did LDL get such a bad rap? Scientists associated LDL cholesterol with heart disease starting in the 1960s, but their primitive tests missed what was really clogging arteries.
Which brings me to number two. Statins don't lower the real risk factor for heart disease. There are two types of LDL cholesterol. One is big and fluffy and buoyant, and the other is small and dense like a bullet. But you'll never know which you have from the standard cholesterol panel. The standard panel merely calculates that LDL from your total cholesterol, your HDL, and your triglycerides. It doesn't differentiate between the fluffy LDL and the bullet LDL. It means almost nothing to me when I want to know your risk of a heart attack, especially if you're insulin resistant. That's why when I check lipids, I order an NMR panel. This stands for nuclear magnetic resonance spectrometry, which directly measures the number of particles and the size of those LDL particles in your blood. The higher number of those small, dense LDL tips me off that something sinister is happening inside your metabolism. That LDL has hung around in your circulation for way too long. And as a result, it oxidizes easily and finds its way into the plaques inside your arteries. But here's the thing. Statins will lower your total LDL, but they also make your LDL smaller, and they don't affect the risk that really matters. Moreover, those statin side effects are not overblown. They're real. My patients report that their muscles ache more, their brain doesn't work as well, and in a lot of cases, you are more likely to get diabetes from a statin than you are to prevent a heart attack.
That's why rather than focusing on LDL, I focus on this: the number one risk for heart disease. That number one risk for heart disease is your LPIR score. The LPIR score is calculated from the particle numbers and the size of your VLDL, your LDL, and your HDL. And we can only get these numbers from that NMR test I mentioned earlier. And although in the past this was primarily used as a marker for insulin resistance, it's actually one of the greatest indicators for your cardiovascular risk.
Let's go over those numbers. This study is looking at a hazard ratio. Hang with me. A hazard ratio compares your relative risk of an event at any given time compared to a control group. This study found that for every standard deviation that your LDL is raised, you have a 38% increased relative risk of getting cardiovascular disease if you're under the age of 55. That sounds big, but in reality, a relative risk this small hardly makes a dent in your real absolute risk. Here's an example of a big relative risk: For each standard deviation that your LPIR score is raised, you're at a 540% increased risk for heart disease. Now, that's a number that gets my attention. In my clinic, preventing heart disease starts with reversing that insulin resistance, not statins.
Click here for the steps on reversing heart disease with autophagy. I'll see you there.