LDL levels for afibbers

I'm 3 months post Natale LAA ablation, and so far it is a blatant success,
The next enemy is cholesterol. I have been on Lipitor 15mg for a number of years as my total level was above 200, and it brought it down to 120. As the short term memory loss was becoming unbearable, I stopped Lipitor, and combined with my post ablation ability to exercise heavily -- and drink heavily at times as well , I was able to prevent a return above 200. I currently stand at 170, with 110 for LDL.
Now, my EP at Mt Sinai insists that for afibbers (I don't know if I still am one, but let's assume so), the LDL should be below 70, and he wants me back on Lipitor.
I am very reluctant given side effect aforementioned, so trying to find out from this forum whether it is tyre that afibbers should be below 70, and more generally a view on levels? Are there other drugs that can treat LDL without the bad side effects of statins?

First - I'll state my bias - I think the "standard" approach is very misguided. I also don't know why it should be different for afbbers except that many non-lone afibbers have coronary artery disease as a co-morbidity.

So

1. Do you have a problem? I'd request a CIMT scan <[www.cedars-sinai.edu] . This is an ultrasound of your carotid arteries. It measures both blockage and intima thickness. The thickness is reported both as mm and as compared to your age. So if you have no blockage and your intima is younger than you are, I don't think you have a problem. All the data on LDL are correlative and infer problems where there may be none. The CIMT directly images disease.

2. Roam around this site: <[www.spacedoc.com] Dr. Graveline was an astronaut as well as physician to the space program. The NASA docs put him on statins and he had HUGE problems with memory and muscles (couldn't walk) as a side effect.

3. From what I can ascertain, the reason statins have any positive effect is they a) reduce inflammation and b) reduce blood viscosity. Both of these objectives can be had other ways and if you use a statin, at a much lower dose than required to drive your LDL level into the dirt.

4. As to why driving your LDL levels into the dirt might not be a good idea for your brain see: <[www.amazon.com] and more generally about cholesterol <[www.amazon.com]

5. As to what you can do - Dr. Gundry's approach results in a huge risk reduction and really caught my attention. In his book, he cites several examples of dramatic plaque reversal.

"Coronary Artery Disease (CAD) is thought to be progressive; standard treatment protocols call for instituting/instructing a low fat/low cholesterol diet program, exercise, and lipid lowering agents in an effort to slow the onset of recurrent MI’s, stents, CABG’s (bypass), stroke, or death. This results in an approximate 30-40% new event rate in 5 yrs."

" Pts have been followed for 1.5 to 10 years (mean 8 yrs). While enrolled, only 6/925 pts (0.6%) have received a new stent, two that were predicted by a rising Lp-PLA2, despite an HDL’s of 110-120 mg/dl. There have been no MI’s, CABG’s, unstable angina, or deaths. One pt underwent carotid endarterectomy for known carotid stenosis; one pt suffered a CVA while in atrial fibrillation. Total CV events over 5 years is 8/925 (0.9%) "
<[circ.ahajournals.org]

Gundry’s approach, including these supplements: 125 consecutive pts, aged 65-86, M:F ratio 3/2, with known vascular risk factors of HTN, DM, Hypercholesterolemia, hx of MI, Stent, CABG, were enrolled in a dietary program, which emphasizes large amts of leafy green vegetables, olive oil, radical reduction of grain, legumes, and fruits; and generous amts of animal proteins (Diet Evolution). All pts were instructed to take 2-4,000 mg of high DHA fish oil, 200mg of Grape Seed Extract, and 50 mg of Pycnogenol per day. All pts had Endothelial Reactivity (ER) using PAT before and after a 5-minute arm occlusion using the EndoPAT 2000 (Itamar, Israel) at baseline and at 6 months. <[atvb.ahajournals.org]

Podcast #1: Dr. Gundry is the Director of The International Heart and Lung Institute in Palm Springs, California, and the Founder/Director of The Center for Restorative Medicine in Palm Springs and Santa Barbara. But he is destined to be known by everyday people outside his field as the author of the life-changing book Dr. Gundry's Diet Evolution: Turn Off the Genes That Are Killing You – and Your Waistline – and Drop the Weight for Good. <>>
[m.soundcloud.com]

Podcast #2:
<[www.podcast.de]

His sites: <[www.drgundry.com] <[www.heartlunginstitute.com]

His book: [www.amazon.com]

6. Terry Wahls MD reversed her very serious MS situation with diet/lifestyle.  It is akin to what Gundry is doing.
Here is her TedX talk: <[terrywahls.com]
Her book:
<[www.amazon.com]
 Her site: < [terrywahls.com]
She thinks that most chronic illnesses are very similar at the cellular level and have inflammation at their core.
 
7. There are more advanced inflammation tests that can be run. One genetic test, APO e may be very useful <[www.gbhealthwatch.com] . About 20% have an 3,4 or 4,4 variant. In these people, animal fat is not your friend. Dr. Gundry treats these people with a low carb, high fat diet including shellfish, extra virgin olive oil, MCT oil and coconut oil. Excluding any other animal fats as well as seed oils (and of course trans fats). By the way, if you have the 3,4 or 4,4 APO e variant, there are indications that statins may promote Alzheimer's! The brain contains 25% of the body's cholesterol and shutting it off is not great for the brain.

8. Shannon told me he saw reversal in his CIMT intima thickness after initiating a course of bio-identical hormone replacement. He knows the CIMT machine rep, who told Shannon that whenever he demoed the machine at a cardiology conference, he got a wide spectrum of results, some very bad. Whenever he demoed at a bio-identical hormone conference, everybody he checked was clean as a whistle, with young arteries.

George



Edited 2 time(s). Last edit at 07/17/2014 02:04PM by GeorgeN.

Hi PH,
Glad to hear all is ship shape after your Natale ablation.

Regarding your Cholestrol, it is an absolute travesty that any Doc would try to push your Total Cjolesterol levels to 170 and below!!
Using 200 as the cut off point for 'normal' Cholesterol levels is purely a Big Pharma driven marketing strategy that flies in the face of what is really known about lipid metabolism and biochemistry.

Cholesterol is the very prime building block of all sex, adrenal or glucocorticoid and other key anabolic hormones essential for life and robust health!

Trying to push total Cholesterol below 180 will come to be seen as a major systemic error in medicine in the years ahead I'm afraid, and the range from 200 to 250 is a better level in combination with decent ratios of HDL relative to LDL and most importantly moderately low triglycerides and healthy LDL particle size and low homocysteine, all of which are far better markers of CVD combined than total cholesterol number is, and trying to force total C so far below 200 is borderline malpractice in my view.

Try to get your total Cholesterol at to 200 while doing more sophisticated lipid profile testing such as at Berkeley Heart Lab and SpectraCell labs among others.
Its little wonder why you are having memory loss problems PH with levels as low as you report! Crazy what some of these docs are recommending.

It's the classic mistaken assumption that if a little bit might be helpful then of course taking it much further will be even better. Next thing they will be shooting for is Zero Cholestrol with a heavy duty triple strength and very expensive statin protocol.

Only if you have truly familial hypercholesterolemia with level close to 300 and above do you typically even need to lower total cholesterol assuming you get the other values mentioned above in a decent range. It's these relatively rare folks that can justify a statin. Give your hormones a break and learn about this controversy. Read cardiologist Dr Stephan Sinatra's new book 'The Great Cholesterol Myth' for an up-to-date review on just who should and should not receive statins... The numbers for whom it is appropriate are vanishingly fewer than the current Pharma driven guidelines would have us all swallow hook line and sinker.

Cheers!
Shannon



Edited 1 time(s). Last edit at 07/18/2014 10:22AM by Shannon.

One thing that has been bothering me about LDL, HDL, VLDL, etc. target levels, is that so many persons (as much as 40 percent of ER visitors I have read) have heart attacks with perfect lipid panels. Many other have high levels and never have a heart attack.

Another paradox is brought about by the recently released as well as re-hashed older niacin studies that now universally discount that drug for use in correcting high cholesterol levels.

But niacin DOES reduce LDL and VLDL down to current standards!

If one were to ignore the side-effect issues of niacin, heart health should have been improved in any case, based on current thinking. So why then, didn't dropping LDL and VLDL levels with niacin result in improved outcomes with regard to heart attacks?

Something is basically wrong here, and I suspect the current thinking regarding cholesterol levels is bad science. But why the adamant buy-in by those highly-educated doctors? Are so many of these professionals just mindless tools of their training?

I have no confidence in the medical industry anymore, other than being a means for physical procedures such as surgery - and even then, let the buyer beware.

Very frustrating.

Tom,

As to niacin, Dr. Gundry published on why... while lowering cholesterol, it raises the level of LP PLA2, an inflammation marker <[circ.ahajournals.org]

George

I concur with Shannon on this, and some of the other comments made above. I would highly recommend the book called, "Overdosed America" by Dr. John Abramson, which says "How the Pharmaceutical companies are corrupting science, misleading doctors and threatening your health". - very interesting read and an eye opener for those who may be unaware of the tremendous influence the Pharmaceutical companies have on SO many medical decisions.
There was another article I read awhile back from a cardiac surgeon that said that ALL of the patients he needed to operate on had one thing in common: Inflammation. If you can keep that down, cholesterol is not usually an issue. Your cholesterol is not that high in the first place - and if your triglycerides are good, HDL is good, then you might want to also get your CRP (C-Reactive protein) measured too - to see how the inflammation is in your body. Your LDL is only slighly elevated, but nothing alarming.

Two things to add here: My first husband died of hypercholesteromia - I don't know what his cholesterol was, as it was in 1981 and no one was paying much attention then (although in his case, they should have as his dad died at age 50 and his grandfather at 33!). It was determind in an autoposy that this is what he had. So if that were your case, then you definitely DO need to pay attention and make some changes to get that lowered. But a reading of 170 indicates that is not even close to being a concern.

Secondly, I have been working in the home care industry for a bit and have noticed so many more people with dementia and Alzheimer's disease. There is speculation that the statin drugs may very well be contributing to this - and I would believe that. The doctors have been very big on promoting statin drugs for quite a few years now - give that to an older person who typically is affected even more by medications, and ....it's not a good scenario.

You are a FORMER Afibber, whose cholesterol is already in a low enough range, who might want to consider another EP if he thinks you need to be on a statin right now. I would just check your other markers, and if they are all good, relax. If they aren't, there are many things you can do to get those numbers in line without going on statins.

Im' not a doctor, but I have done a lot of reading on health for years (since husband #1 died, actually)...and this is my opinion, for whatever it's worth

Best to you ~ Barb

Wow, I wanted to get on this thread and rant about the whole cholesterol myth, but George, , Shannon, Tom and Barb covered it beautifully.

Well said all

John

PH,
If you are not already familiar with Dr. Timothy J Smith, I would like to make you aware of an on-line book which he has authored, and which can be read on-line, and printed if so desired, at no charge. The title is "Outsmarting the number one Killer". Simply written, easy to read, it will leave you with a good understanding of LDL and other cholesterol, and most everything associated with atherosclerosis. The book has a wealth of information. You might just scroll through the table of contents to see if the information might be of value to you. The principles Dr Smith follows are pretty much those which most on this forum try to aline with in addressing their Afib.
[www.google.com]

GeorgeN Wrote:
-------------------------------------------------------
> Tom,
>
> As to niacin, Dr. Gundry published on why...
> while lowering cholesterol, it raises the level of
> LP PLA2, an inflammation marker
> <[circ.ahajournals.org]
> bstract/124/21_MeetingAbstracts/A16318
>
> George

Thanks George, that was very interesting - I guess it remains to be seen if any yet-to-be disclosed long-term side-effects of statin use will prove to be of similar offset to to overall benefit. Certainly there are enough immediate negative side-effects already known to us.

Tom

"The next enemy is cholesterol."
You are equipped by your obvious skill with the english language to form your own opinion about whether cholesterol is actually your enemy. Here is a list of cholesterol debunking websites that i have accumulated over the years. I hope it is helpful to you.

[www.afibbers.org]

PeggyM

I think taking vitamin D should improve your cholesterol levels.
I am about to have blood tests for cholesterol and vitamin D next week, after taking vitamin D for 12 months.
The results will be interesting.

Colin

My Cholesterol was 184 but my LDL was 115. All my other readings were normal that is HDL, Triglycerides etc.

My doctor wants my LDL at 70! He wantaed me to go on a statin or back on Lipitor but I refused. I told him the side effects were to bad.

Why they want my LDL at 70 amazes me. I have 1 stent and I am in NSR and have been for months. My 5 month anniversary is coming up July 27 with Dr. Natale.

I stopped taking Lipitor over 6 months ago. I did lower my cholesterol from 239 to 184 and my LDL from 129 to 115 taking Quercentin.

I am having to stop the Quercentin until I can get off this antibiotic Cipro. It is considered a NSAID by many and that does not mix well with Cipro. Neither does Aspirin but I am taking my aspirin 5 hours after I take my Cipro 500 mg tablet.

Smackman.

Your DOC is nuts trying to push your LDL to 70, with your total Cholesterol at 184 already! An LDL of 115 is perfectly fine as a number... but as with any total number like that its usefulness is limited. Keep in mind that 50% of all people who drop dead from a sudden heart attack have perfectly optimal cholesterol numbers bases on the guidelines.

When 50% of the people fail your protocol, there is something seriously wrong with the logic and assumptions being applied with said protocol. Don't listen to anyone trying to drive your total cholesterol into the ground in a myopic focus on trying to hit some supposedly magic number of LDL 70!!

Its blows my mind how otherwise docs can get so off track by looking for a simple one number answer to a complex metabolic issue like arteriosclerosis. Go to SpectraCell Labs website which is located in Houston and get the Cardiometabolic profile. You can plug in their search for practitioner by State and will find quite a few in Louisana who are familiar with and can order this test.

SpectraCell Labs LDL particle size test. This test which covers as well all the traditional lipid markers gives far greater insight and detail into your true CVD risk than a standard lipid profile.

Any Doc who is savvy enough to know about and use these tests will certainly not be a blinded slave to the cholesterol is ALL mantra and should be able to give you better guidance on this issue.

If you attempt to drive your LDL down to 70 using more statins when your LDL is at a decent 115 now and your total Cholesterol is already at a very low 184, I can almost guarantee you a big loss in energy, memory and for sure what ever libido there is now will take a major swan dive off the high board as the remaining anabolic hormones you do have will get hammered even further.

Shannon

Can cholesterol be atherogenic. Yes. The best indicator out of a standard lipid test is the triglyceride to HDL ratio. Ideally this should be 1 or less and certainly less than 2. Usually, triglycerides are a function of carbs in the diet. Reduce carbs, lower triglycerides and raise HDL. If you are APO e variant of 4 (see my post above), this may not be the only reason.

My take is that bad ratios are an indicator to change the input (diet), not use a med to drive the LDLs to tiny numbers. The best docs I know use statins sparingly and only as a short term bridge till lifestyle modifications kick in. In a very few cases, they may use them long term, but certainly not handing them out to a large percentage of their patient population.

The best data I am aware of suggest that particle count, along with particle size are the best predictors, as in the Liposcience NMR test: <[www.liposcience.com] which can be ordered for any LabCorps location (in the US) here for $75: <[www.walkinlab.com]

If you want to know more about the NMR test, Peter Attia MD has written about it quite a bit: <[fficial&client=firefox-a&channel=sb" rel="nofollow">www.google.com]

Personally, I make changes to my diet/lifestyle & rerun the test. When my results were not as expected, it caused me to run the APO e test (more info in my post above). My results showed I had a 3,4 variant. This explained my results perfectly. The optimal diet for an APO e4 is low carb, high fat vegan with shellfish. Unfiltered extra virgin olive oil, palm and coconut oils are OK.

George

Great find Larry. This pdf book is 199 pages. So download and save it. A lot to go through for sure.
[www.timsmithmd.com]

Todd,
Glad you connect with Dr. Smiths approach to medicine, and recognize the value of the information he has extended. Much of what he says regarding cardiovascular disease and the testing markers and nutritional medicine recommendations he makes, also apply to A-fib. I have found it easy, and so far rewarding (4 year window), to integrate his cardiovascular suggestions into my A-fib protocol, providing a well balanced approach to addressing both. Understanding results of marker testing in the areas which he discusses, can have profound positive results towards better addressing A-fib.

(Lone A-fib, four years into addressing it through diet, exercise, supplementation, no pharmaceuticals.)
Good reading.....

I don't see any talk about Ultra fast CT-scans for showing (in stark white on a grey background) any calcium deposits in the coronary arteries...

CT scans are useful. My understanding is they don't show the soft plaque, which is the most dangerous kind as it can detach. Hence the carotid ultrasound ought to be run also.

Is there likely to be soft plaque in the absence of any calcium? Especially when 2 scans 10 years apart show no calcium? Wouldn't soft plaque during that period turn into calcium?

I would agree with you in that circumstance, but it is truly beyond my pay grade...

Mine too - I got an Ultra Fast CT scan 10 yrs ago and also recently and both showed zero calcification except a little bit in the Aorta. So I was kinda hoping the soft plaque stuff would be absent too. That was the opinion of the cardiologist that reviewed the scan results anyway. There's a book (yes another) and there used to be a blog run by Dr William Davis who talks about using these Ultra fast CT scans as part of a healthy heart regimen (which doesn't worry about LDL unless particle size is taken into account).

[www.amazon.com]



Edited 1 time(s). Last edit at 07/23/2014 07:53AM by afhound99.

My EP also wants my LDL below 70, as an Afibber or former Afibber. I checked with my recent ablation surgeon and he said. He had no problem with me being back on Lipitor. I'm confused because both doctors are quite renowned. My total is 174 and LDL at 114.
Based on prelim research, two advantages of Lipitor, besides lowering a *number*, are anti-oxidant and blood thinning. Assuming my 6 months TEE is good and I can be off Xarelto, I was thinking that the thinning aspect might be taken care of by daily aspirin, but maybe I'm naive. As far as antioxidants, there are many natural supplements that do that, no hassle.
I'm getting a third opinion and will research all the references above, but I am confused right now.



Edited 2 time(s). Last edit at 07/23/2014 06:34AM by PH.

This is extracted from an article by Dr William Davis (author of "Wheat Belly" and ultra fast CT scan expert) - it's subject is Aorta enlargenent but touches on LDL. He has many other articles out there on LDL and what levels of what types of LDL are problematical.

Correction of lipoprotein abnormalities (e.g., small LDL and lipoprotein(a)). Note that this is not the same as correcting "cholesterol" abnormalities. Cholesterol does not cause heart disease; lipoproteins (lipid-carrying proteins) cause heart disease. Cholesterol is just a convenience of measurement. Measuring and quantifying lipoproteins provides genuine insight into how the aorta can be weakened.

[www.healthcentral.com]

Small LDL and triglycerides usually tend to be correlated with carbs in the diet. I say usually, because with my APO E4 gene, animal fat is also correlated with trigs. I'm not sure about the small dense LDL, we'll find out.

There are interesting reversal stories from vastly different approaches. Dr. Patel, describes his n=1 experiment using a very low carb with once a week carb cycling (Carb Nite) <[azsunfm.blogspot.com] He has very high LDL-P while his CIMT thickness and some calcification reverses.

At the other end of the spectrum is Dr. Esselstyn, with his very low fat vegan approach: <www.dresselstyn.com/Esselstyn_Three-case-reports_Exp-Clin-Cardiol-July-2014.pdf <[www.dresselstyn.com] <[www.dresselstyn.com] <[www.youtube.com]

Then there is Dr. Gundry's approach, linked in my first post above in this thread. He advocates a low carb, high non-starchy veggie but also high fat approach.

Even with Esselstyn's carbier approach, insulin/blood sugar decrease, so if I had to name one thing that is common, it is control on insulin/blood sugar. However, I've done that very well and, with my E4 gene, it is not enough.



Edited 1 time(s). Last edit at 07/23/2014 03:40PM by GeorgeN.

Is a fast CT scan the same as a heart and lung calcium scan? I'm told it is a very low dose of radiation so Jo concern, is that true?
I met with the skin doctor recently, the one who first mentioned the memory loss side effect of Lipitor, and he said that his cholesterol level is 250 but since his calcium scan showed nothing, he doesn't care about his 250 level.
I discussed this situation with my generalist GP, who is actually a cardiologist, and he completely agrees with the approach. He also mentioned a new test for artery plaque called PLAC (www.plactest.com) but he said it is very new so no opinion yet.
One thing I will check is whether St. David hospital measured my calcium level as they did a fairly advanced CT scan pre-ablation 5 months ago, and maybe the data is available?
Otherwise, 5 months post ablation and steady steady NSR. My new connection with Bordeaux is that I restarted drinking the great wines that come from that region, but little to no contact with Haut Leveque...