"For how long Brian?
If the single death (Tim Russert's Sudden Cardiac Death) didn't happen on cue,
when did it happen?
A few months later, or many years later?
Given that 110/111 not changed, (I have no idea what this ratio means)
it's important to know how much extra time the lucky guy got"
To me Ivor's response about Tim Russert's case (link) is almost incoherent.
I don't think Tim was lucky
I think if a non-HDLc was calculated his Doctor wound have realized Tim was not treated to goal
with his present medication.
Tim had a nuclear stress test one month before his sudden death.
Since it was normal his Doc thought Tim was bulletproof with LDLc 68.
If the Doc calculated:
Total Cholesterol minus HDLc = Non HDLc the Doc would have realized
Tim had discordance due to his metabolic syndrome.
Ivor, this is a month, before Tim had sudden death with no other symptoms.
I suspect in the surgical and intervention atmosphere of then and now:
Tim would have had an angio stent or bypass surgery.
He would be alive today.
Thus I have answered Ivor's question above (repeated below):
"For how long Brian?
If the single death (Tim Russert's Sudden Cardiac Death) didn't happen on cue,
when did it happen?
A few months later, or many years later?"
And yes non-HDLc discordance and apoB or LDLp further discordance would have alerted Tim's Doctor to do further testing and Tim would be alive today. In my opinion.
Ivor writes:
His diabetes, Trig/HDL, remnant cholesterol etc. showed that he was in for a shaky future - sure. The ApoB doesn't add much to the assessment, if you're riddled with outrageous markers...
I can only think that since Ivor does not treat sick patients he is way out of his wheelhouse.
If Russert's Doc did not calculate, or get a Apo B, or LDLp I doubt he had any idea about remnants.
A simple non-HDLc (The Tubby Factor) would have alerted Doc to discordance and incomplete treatment. Even today many Docs don't know what non-HDLc is.
Total cholesterol minus HDLc = non-HDLc
Much easier than ratios. Simple subtraction.
Numbers obtained from standard lipid panel.
No new cost.
No excuse not to make it the main parameter for CVD risk.
Explanation of The Tubby Factor link
Irish Medical Nihilism Link
No comments:
Post a Comment