I give up…

[GetMeOuttaThisMess]

If not interested in medical studies don’t waste your time with this post.

https://www.cnn.com/2022/11/21/health/hdl-cholesterol-study/index.html

https://www.diabetes.co.uk/news/news/2022/nov/age-related-macular-degeneration-strongly-associated-with-serious-forms-of-cardiovascular-disease.html.  Leave it to me to fall into this small subset where there appears to be a benefit to ocular vitamins, which I do take at the recommendation of my optometrist.

[MediMike]

While I know there has always been a significant emphasis on higher HDL levels being good, nobody is ignoring the LDL right? Or have folks been giving patients with both high HDL and LDL a free pass?

The racial disparity is super interesting though, wonder what other factors are driving this. Could assume higher rates of inflammation due to higher incidence of diabetes, maybe nutritional issues in setting of socioeconomic status? General access to care? Have been association with the anti-inflammatory effects of HDL and cardiovascular risk in other studies if I remember right. Genetic?

It's been great to see all the of the studies the last several years showing the medicine isn't blind and we can't take a cookie cutter approach to all ethnicities.

Here's the original article: https://www.jacc.org/doi/10.1016/j.jacc.2022.09.027

Edited November 22, 2022 by MediMike

[GetMeOuttaThisMess]

It was my understanding as I skimmed it that the LDL's were still felt to be bad.  What I haven't gotten my head around are the Ca+ Index scores.  You do the scan to look for calcified plaques.  The problem is that this week still the understanding is that those are the STABLE plaques.  It's the soft, gooey, non-calcified plaques which are the risk.  I'm starting to come around to the idea that the majority of sx. CAD cases are micro versus macrovascular (as seen in European studies) and that coronary artery spasm cases are greater in number than we suspect.

Edited November 22, 2022 by GetMeOuttaThisMess

[CornellSPA]

I think as we pivot away from cholesterol & ratios and look more to inflammatory markers (Lp-a, homocysteine, hs-CRP, Type A and B etc) we will see even less importance across the board for both HDL and LDL.....luckily through quest we can do clevelandheartlab panel on almost everyone and get all this data! Boston heart runs an amazing lipid panel also, but coverage is not as good. 

[rev ronin]

Just remember that just about everything except patient death is a substitute endpoint.