Low triglycerides, high LDL

[Mom2One]

I had my cholesterol checked a few months ago and it was high. Doctor of course wanted to put me on meds but I declined. Told him I wanted to try diet and exercise first. He wasn't thrilled, but I wasn't really giving him a choice. I had my cholesterol checked again last week. I have lost 15+ pounds through exercise and the "Sugar Busters" diet (low sugar, fairly low carb diet). Here's what my readings looked like both times:

July October
Total 276 253
HDL 44 55
TC/HDL 6.3 4.6
LDL 224 192
VLDL 8
Triglycerides 42 < 45
Weight 170 153

The nurse that did my test at the health club last week said that it is very unusual to have such low triglycerides with such a high LDL reading. (Of course she also insisted that I should be on a low fat diet because obviously my low carb diet wasn't working. <cough cough> ) I have no plans to take any rx drugs to lower my cholesterol, but I don't know what to do about this high LDL. Also, does anyone know why I would have a high LDL with low triglycerides. They were low even before I started Sugar Busters, so I can't really say that a low carb diet is responsible for that.

Thanks!

Lisa


[This message has been edited by Mom2One (edited 10-12-2002).]

[arkie6]

LDL cholesterol can be broken down into two kinds, pattern A and pattern B. LDL pattern A is large fluffy particles that are less dense than pattern B and not easily oxidized. LDL pattern A is essentially benign with respect to heart disease. LDL pattern B on the other hand is small dense particles that are easily oxidized and more closely associated with heart disease. It has been theorized that the harm to the arteries is associated with oxidized cholesterol. Ok, enough about that. To summarize, LDL pattern B (think small dense BBs) is bad, LDL pattern A (light and fluffy) is not a problem.

Now you would think that the lab actually measured your LDL, but they likely didn't. Most labs just calculate LDL from the following equation: LDL = Total Cholesterol - HDL - triglycerides/5. So from this, you don't know if you are predominately LDL pattern A (no big deal) or predominately LDL pattern B (much more risk). Some labs do have the capability to measure the LDL gradient and can determine your predominate LDL pattern type. However, there is another way. Studies have shown that there is a strong correlation between a low triglyceride/high HDL level and LDL pattern A (the non risky kind), and conversely, a high triglyceride/low HDL level is strongly associated with LDL pattern B (the harmful kind). This is one reason that high triglycerides alone are an independent risk factor for heart diease.

Ok, where am I going with this with respect to your situation. Other studies have shown that a high triglyceride/HDL ratio is the best indicator for heart disease risk (approximately 8x better at predicting heart disease risk than high total cholesterol alone). A triglyeride/HDL ratio of 5.0 is moderate risk and the higher the number, the higher the risk, while a ratio of < 2.0 is very low risk.

From what I have just described, you can see that with your very low triglyceride level (<100) and moderately high HDL level (>50) you are at very low risk of heart disease. Also, your very low triglyceride level indicates that your LDL is predominately pattern A, the harmless kind. If you are still concerned, you can have your LDL gradient measured to determine your LDL pattern type.

I wouldn't even remotely consider cholesterol lowering medications without knowing your LDL pattern type to see if there is any risk associated with your lipid levels because there are potential significant side effects (muscle damage, neurological damage, liver damage, even death - i.e. the Baycol recall) associated with many cholesterol lowering medications (statins in particular).

Oh, and I think that your low sugar, lower carbohydrate diet is the way to go to lower your risk of heart disease because of the positive effects it has on triglycerides and HDL.

Alan

[Mom2One]

Thank you, Alan, for such a detailed response. Since my doctor was so quick to react to my high LDL at my appointment a few months ago, in spite of my low triglycerides, I assume he is unaware of this research. I did a search on Medscape and came up with the journal article that discussed the two different types of LDL. I'm going to take it to him at my next appointment. Thanks so much for the info! I would have never found this without your help!

Lisa


[This message has been edited by Mom2One (edited 10-12-2002).]

[hunter44]

Mom2One - Better yet cut and paste Arkie's response and show it to your doctor, Arkie gave you some excellent info. The only thing that I can add is that a low carb diet usually shows results after about six months, but your numbers weren't that high to begin with. So your numbers and ratios should see more improvement in the future. Some people actually experiernce slightly higher numbers from low carb because good levels increase,i.e., my HDL went from 54 to 73 after six months, and my total still dropped 23%. Most doctors are quick to prescribe a statin. I think most doctors get their education regarding cholesterol from their drug reps. I experienced dramatic changes in my numbers/ratios eating low carb.

[ARIZONA73]

Arkie6:

I have found your reply most interesting. When you speak about pattern A and pattern B LDL, is this essentially the same as Apolipoprotein A & B? I have never seen such a breakdown of LDL on any of my blood reports either. It certainly seems that such a distinction should be made before even considering drug treatment. I am beginning to believe that many doctors themselves are not sure when drug treatment is appropriate and when it is not. In any event, I found your reply most interesting.