The Tubby Factor explained

Non-HDL cholesterol, what is it?

This term is a mouth full. 

In 2010 I suggested we replace non-HDLc with one easier to remember:

The Tubby Factor

Tim Russert died of sudden coronary death on 6-14-2008 with LDLc of 68.

He had metabolic syndrome.

Tim Russert's lab:  

1- Waist greater than 40"  

2- HDLc 37 (it had been in the 20's)

3- Triglycerides 399 (supposedly taking Niacin 2g and Tricor 145)

4- Fasting glucose greater than 99

5- He was on anti-hypertensive medications

Mr. Russert had all five of the criteria for metabolic syndrome.

Mr. Russert was treated to goal of 68 LDLc on statin.

However he was not at non-HDLc goal less than 80.

His non-HDLc was Total cholesterol minus HDLc

TC 155 minus HDLc 37= 118 non-HDLc

After Mr. Russert's surprising episode of SUDDEN DEATH,

the cardiology and CV surgeons on TV said everything was done that could have been done. 

Lipidologists were not interviewed or where afraid to teach the importance of LDLp or apoB particle levels once you find the 

non-HDLc was high after Rx. 

I found Peter's Attia article on internet and posted this excellent chart showing the increased discordance between LDLc and LDLp

This is why I wrote The Tubby Theory from Topeka in 2010.
It was well known among Lipidologists that Mr. Russert was not treated to goal.
Even though he had a normal nuclear stress test,  no one mentioned Glagov remodeling of arteries.
Mr. Russert had coronary plaque that a nuclear stress missed because the plaque did not block off greater than 70% of the coronary artery.  His CAC CT score was 200 ten years earlier.

I believe Doctors did not know about non-HDLc because the term was too cumbersome.  I choose to coin a new term.  The Tubby Factor.   I hope patients would go to their Doctors and ask what their Tubby Factor was.  Dr. Thomas Dayspring did not like the term because 20% of people with metabolic syndrome do not have a large waist.  For the general public I thought it was adequate.  Even in a great book on keto-diets,  Eat Rich and Live Long, Cummings and Gerber fail to mention non-HDLc as a much better biomarker than LDLc in 2018.

I write again about this topic with the help of Dr. Peter Attia's chart to teach the importance of discordance and correcting it with calculating non-HDLc from routine lipid panel or getting advanced lipid testing with LDLp or ApoB particle counts.