What is really important about your Cholesterol Panel?
It's the Triglyceride to HDL Ratio!
For many years most doctors have focused intently on their patients LDL Cholesterol which is actually not a great marker for heart attack risk because, fueled by money from the makers of LDL Cholesterol lowering medicines, they had been barraged with information on how much they could help their patients by doing this. There are even financial incentives for many of them as HMO's often pay bonuses for "quality care" and one of the factors used to calculate payments is how much the doctor has managed to lower his patient's LDLs using statin Cholesterol medicines like Crestor and Lipitor. If they decide not to prescribe Statins they can face sanctions and ridicule from Credentialing boards, professional assiciations and State Licensing Boards. Statins actually have very little benefit for most people. Heres a nice article on that by practicing Cardiologist, William Davis MD.
What is really important is the ratio of your triglycerides divided by your HDL Cholesterol. Here's why!
First, it is the best predictor of heart disease risk. In this study 374 people who had their Cholesterol Panels drawn then underwent heart catheterization to have the extent of any blocked heart arteries assessed, here's what they found "Nearly all routinely assessed lipid variables were associated with the extent of coronary disease, but only the ratio of triglycerides to HDL-cholesterol or to HDL-c were robustly associated with disease extent. Elevation in the ratio of TG to HDL-c was the single most powerful predictor of extensive coronary heart disease among all the lipid variables examined." Read the study here.
Insulin resistance, probably the main factor leading to the "Metabolic Syndrome" (article) which in one 6 year 6000 person study by the National Center for Health Statistics institutional review board was found to affect 34% of Americans (see article published in JAMA here) is a major risk factor for developing obesity, diabetes and heart disease. (article here) . The blood marker found to most strongly correlate with insulin resistance was a high triglyceride to HDL ratio. (article)
And finally some types of LDL Cholesterol are known to be more likely to cause heart attacks than others, namely it is the small dense, oxidized particles that are the main culprit. In this 5 year study done in Quebec (article here) not only did they find small dense LDL particles a major risk factor for the development of heart disease. Also found that both the HDL level and the HDL/total Cholesterol levels were more important markers of heart disease risk than LDL Cholesterol.
So many patients on low carb, high fat diets see a rise in their LDL Cholesterol, Go to their doctor and are told their Cholesterol Panel looks terrible, despite the fact that their HDL has gone up and their triglycerides have plummeted. Based on the data above as a physician I find this NOT TO BE an evidence based, practice of medicine. I am hoping some day randomized trials will be done to compare heart disease risk in people on true low carb (less than 50 grams/day), high fat diets and people on low fat diets but frankly the Statin makers can see the risk of a serious downside to their bottom line if these studies were to show the superiority of this approach and continue to use their influence to block such research. This research would be difficult to find funding for anyway as there is no money to be made here by pharmaceutical companies. You cannot patent telling someone to stop eating sugar and so many carbohydrates. Still the evidence continues to mount and the number of doctors and researchers supporting a low carb, high fat approach grows daily. For the sake of your health, you owe it to yourself to investigate the data yourself and make your own decisions as paradigm changes like this in medicine often take decades.