5 Steps to prevent Heart Disease

Thursday, May 10, 2018

My search for truth with @DaveKeto See UPDATE below

What is high LDLc?

2017,  2018 articles redefine what a normal LDLc is.
Now it depends on what risk factors the patient has.

I took @DaveKeto lipid challenge.  I thought I had answered the lipid challenge with
Coronary Heart Disease Risks Associated with High Levels of HDL Cholesterol 2014

I was shocked by his reply on twitter.  I thought we had a very congenial conversation.

He became angry with because I presented his position as I understood it from our many tweets.
He explained with:

Well folks I don't think I wrote in the first photo what he thinks I wrote.

1- He has never stated to me what a high LDLc as a definite number.  I inferred from his statements he did not think my case's LDLc was  a "high LDLc" from our chatter.

2-I did not say he "changed the criteria of the challenge".  I simply note he pointed out that people in the study smoked and drank which is not in the challenge.

3- I never use the verb insist.  I simply state "Dave says".  No doubt he feels I didn't understand what I think he said.

4- His challenge states the people in the study have to start out being healthy.

5-I did not say he never discussed "high rate of CVD" with me.  To this day he has not defined what "a high rate of CVD" is.

I believe if you read what "Dave says" you will realize @DaveKeto has not represented what I wrote.

Now lets look in the weeds.

Dave mentions alcohol.

Dave using smoking data
Dave points out smokers in the trial.

I have not seen "high rates of CVD" specified in the challenge.

See challenge above, where does he specify what "HIGH RATES OF CARDIOVASCULAR DISEASE" is?

Dave has never specified target number for HIGH HDLc, LOW triglyceride,  HIGH LDLc

Normal is no CVD.  Below average CVD is still a high rate of CVD as it is epidemic in USA.

I will grant Dave's assertion that the baseline strata in men and women start in mid to  late 50s as it doesn't change my point about the second column in the bar graph above.  The second column is for the age group 40- 59 years old.  The per cent of that age group having CAD is roughly 6 per cent.
 I think that is the average "high rate of CAD" for the group in my study that answered the challenge.  Coronary Heart Disease Risks Associated with High Levels of HDL Cholesterol

Last column below meets @DaveKeto challenge criteria

HDLc greater than 90

Triglycerides 76

LDLc 102 (goal 70, needs statin treatment)

non-HDLc 116 (goal 80, needs statin Rx)

These patients developed coronary artery disease during study.

The average rate of CVD in the bar chart that Dave found is 6% for our age group here. 50 to 60 years old.

The mortality rate for men in the last column is 43.4% and for women it's 21%

The CHD event rate for men in the last column is 10% and for women it's 8.9%

I hesitate to characterize what Dave meant by high "rate of CAD" as he never specifically said as best I can figure. However I think he meant a rate higher than average in USA (which is at epidemic levels)

By my presentation I believe I answer Dave's challenge.

I can understand he think 105 LDLc is not high. (however, goal of LDLc in patients with CVD is 70)
LDLc not the best biomarker, the non-HDLc was 116. (the goal of non-HDLc in patient with CVD is 80)

Then I found what I thought was a second answer to Dave's challenge.

 these are numbers after 1 month of run-in use of Pitavastatin for everyone before real trial began.

HDLc: 50.7

Triglycerides: 124

LDLc: 88.1

History of acute coronary syndrome 71%

Diabetes 70%

Hypertension 75%

Smoking 15%

UPDATE 5-9-18
Mistakenly, I thought baseline statin use before Pitavastatin was 
low.  As seen below it was 91%! 

Thus clearly, it does not fit @DaveKeto challenge criteria

 but, I think it validates my first answer to Dave's challenge. 

 It shows that a "high LDLc" can be as low as 88 
because high dose Pitavastatin with lower LDLc had less mortalitythan low dose Pitavastatin.

It also shows these 11,000 people developed CAD with normal HDLc and TG. 
Thus the protective effect of HDLc and Triglycerides did not help them.  

Before this Pitavastatin trial these people already had low LDLc 100 to 110 while 91% of these people were on a statin. Going on high dose pitvastatin and lowering run-in baseline LDLc 88 to even lower levels improved mortality. Thus this new trial is re-defining what a low LDLc is.
Odyssey and Fournier trials have shown improvement with LDLc down to 40.

NLA guidelines for treating cholesterol. Update 2018

I think these guidelines show that LDLc greater than 100 can be high.

Non-HDLc is a better predictor and should be less than 130.

Update 5-11-18

These are answers from Dave on twitter:

"Intellectual Honesty" from Ivor Cummings?

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