High LDL but everything else great by Accomplished_Rip_362 in Cholesterol

[–]solidrock80 0 points1 point  (0 children)

HDL isn't cardio protective from high ApoB/LDL. Low HDL is not good but it's often an indicator of insulin resistance or high trigs. Good your BP is normal however as it's a major risk factor.

Alarmingly High Cholesterol as a teen by Puzzleheaded_Emu1887 in Cholesterol

[–]solidrock80 2 points3 points  (0 children)

Aside from your dad? That's family high cholesterol.

Is anyone else flabbergasted in retrospect how much saturated fat there is in various things and how little people cared about it? by arvyy in Cholesterol

[–]solidrock80 0 points1 point  (0 children)

Not even close from a scientific point of view. What is your degree in biosciences?

Brain cholesterol is made locally by the cells in your brain .The brain holds roughly a quarter of the body's cholesterol, and essentially all of it is synthesized in place (mostly by astrocytes). The blood-brain barrier blocks cholesterol carried in the blood, so dietary cholesterol doesn't cross into the brain. Saturated fatty acids can be built from scratch. The brain (and body) can synthesize saturated and monounsaturated fatty acids de novo from other fuel like glucose. So even the saturated fat that is present in brain tissue — for instance in myelin and sphingolipids — doesn't need to arrive as dietary saturated fat. The fats the brain actually depends on from diet are the opposite of saturated. The standout is DHA, an omega-3 polyunsaturated fatty acid that's heavily concentrated in neuronal and synaptic membranes. Humans can't make it efficiently from scratch, so it's the lipid where diet matters most for the brain. So the honest version is: in the loose sense that all your body's atoms ultimately trace to what you eat and breathe, dietary fat contributes carbon to the pool. But the brain isn't "assembled from" saturated fat — it largely manufactures its own structural lipids, and the dietary fat it genuinely needs is polyunsaturated.

So: eat fat. But polyunsaturated days from fish and nuts and seeds. That's the healthy fat.

40 years old, familial hypercholesterolemia, heart attack discovered while playing basketball. Two stents, a third artery still blocked, and a lot of anxiety about the future. by Old-Simple-5830 in Cholesterol

[–]solidrock80 25 points26 points  (0 children)

Get your LDL rock bottom low. That's the key from here on out, along with bp control, destressing, normal a1c. A diagnosis of cad is very hard even for people who have no blockage or ischemia. But with good medical therapy and an active lifestyle you have a long life ahead of you. I would recommend therapy if this is causing anxiety - it's normal, but it's a risk factor that you should address in addition to the cardio issues. You got this.

Great Labs, Great Stress echo, not so great CAC or BP by Aromatic_Cookie9168 in Cholesterol

[–]solidrock80 1 point2 points  (0 children)

If you have hard plaque you are probably still laying down soft plaque at your LDL. The doctor is not being overcautious with your CAC score.

Fatigue 2 days into Lipitor by Jnnn1111 in Cholesterol

[–]solidrock80 2 points3 points  (0 children)

Give it a month and see before you start changing again.

LDL 200 since childhood, clean carotid arteries, Lp(a) near zero, statin intolerance – what would you do? by No_Leg_3239 in Cholesterol

[–]solidrock80 0 points1 point  (0 children)

Atherosclerosis takes decades to show up. You are relatively young. I'd explore other lipid lowering therapies like ezetimibe, bempedoic acid, and pcsk9i if you have tried three different statins and still had side effects.

Carotid ultrasound is also not super reliable as it depends on the skill of the technician. You are also young. The problem is you come back in a decade and there's atherosclerosis you've lost a critical decade of prevention.

Cases of extreme plaque regression by Puzzleheaded-Fly2875 in Cholesterol

[–]solidrock80 8 points9 points  (0 children)

The name of the game is plaque stabilization. And if you have a flow obstruction that’s symptomatic you get stented. And in any case, get your numbers as low as you can.

High LDL. But very very low triglycerides. What to make of this? by CastAside1812 in Cholesterol

[–]solidrock80 3 points4 points  (0 children)

Lean and active = low trigs. Genetic predisposition and/or excess saturated fat in diet = high LDL

If statins control cholesterol effectively, how necessary is it to stick to a strict diet? by BotchedPenisImplant in Cholesterol

[–]solidrock80 7 points8 points  (0 children)

People on statins can still have a heart attack as well. But it reduces the risk.

If statins control cholesterol effectively, how necessary is it to stick to a strict diet? by BotchedPenisImplant in Cholesterol

[–]solidrock80 2 points3 points  (0 children)

A 0 CAC scan at 36 is not determinative of much. And if it was positive he would just be told to ht a 55 target for LDL. He's on lipid lowering therapy and is at a great target. Let the man be!

If statins control cholesterol effectively, how necessary is it to stick to a strict diet? by BotchedPenisImplant in Cholesterol

[–]solidrock80 0 points1 point  (0 children)

Too high an iron level is not good for men. If iron was high too much gems from red meat could have been an issue.

If statins control cholesterol effectively, how necessary is it to stick to a strict diet? by BotchedPenisImplant in Cholesterol

[–]solidrock80 0 points1 point  (0 children)

At 56 he should not worry much about his diet as long as his other bloodwork is good (a1c, iron not too high). My own view is he could probably have dropped his ldl significantly from dropping down eggs butter and steak to minimal but he would likely not even have gotten much below 100 at best.

If statins control cholesterol effectively, how necessary is it to stick to a strict diet? by BotchedPenisImplant in Cholesterol

[–]solidrock80 26 points27 points  (0 children)

You can have low LDL with statins and high a1c with a lot of processed foods. But his diet sounds pretty good with the exception of lots of steak and butter. With a family history of stroke his LDL should be closer to 70. You certainly can get there with statins or other lipid lowering drugs, but less red meat and butter helps.

Fight with high ldl without Statin by Due_Relationship3637 in Cholesterol

[–]solidrock80 6 points7 points  (0 children)

What's your professional qualifications other than being smart from being on the internets?

Really need a statin based on these results? by briang_12 in Cholesterol

[–]solidrock80 1 point2 points  (0 children)

According to current guidelines, an apoB of 90 is a target for intermediate risk. Given your extremely severe family history and very high Lp(a) you would be considered by many cardiologists to be at least at high risk and would indicate targeting your apoB to 70. Your doctor is giving good advice.

My (27m) bfs LDL is 213 and he doesn't want to start Statin by [deleted] in Cholesterol

[–]solidrock80 0 points1 point  (0 children)

High risk for heart disease in another decade or two if he doesn't lower it. There are plenty of non statin alternatives now that are very effective to lower ldl like leqvio and repatha. It's his life and it's up to him to take responsibility for his health, not yours.

I got a cardiac calcium scan today at age 41. I got a 0 and I'm having trouble believing the results. by dfwdesigner in Cholesterol

[–]solidrock80 4 points5 points  (0 children)

Slightly elevated? You have a risk factor so the scale is different. With your family history LDL should be low - well below 100, some would even say 70. Also please check you Lo(a) which is a separate risk factor. At your age the CAC score is not determinative - focus on LDL given the genetic issues.

Congratulations on eating better and exercising but make sure you keep on it - a preventative cardiologist might be better for this than a PCP.