THE LIPID DEBATE: WHAT S NEW? Dr Detloff Rump

Agenda The Statin debate The TChol/LDL/HDL/Trig debate The ratio debate Conclusions 2

Statins 3

There is an academic debate and it is not concluded 4

..and the debate is about. https://theconversation.com/bmj-vs-the-lancet-there-are-no-winners-in-the-statins-war-65593 5

..and the debate is about. https://theconversation.com/bmj-vs-the-lancet-there-are-no-winners-in-the-statins-war-65593 6

Firstly: How effective are statins? 7

How does this stack up? 8

So there are benefits, but they seem limited http://www.bendbulletin.com/health/4954532-151/weighing-risks-and-rewards-of-statins 9

Secondly: Are statins safe? There are doubts https://therenegadepharmacist.com/should-you-take-statinswhat-happens-to-your-body-when-you-take-statins/ 10

Firstly: Are statins safe? There are doubts 11

but there appear to be non-doubters https://drmalcolmkendrick.org/2017/05/08/its-official-statins-do-not-have-any-side-effects/ 12

and he is referring to. Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm (ASCOT- LLA): a randomised double-blind placebo-controlled trial 13

but there appear to be non-doubters https://drmalcolmkendrick.org/2017/05/08/its-official-statins-do-not-have-any-side-effects/ 14

JAMA recommendations for 2017 ASCVD=Atherosclerotic Cardiovascular Disease 15

JAMA recommendations for 2017 ASCVD=Atherosclerotic Cardiovascular Disease 16

TChol / LDL / HDL / Trig ratios 17

Cholesterol elevation and heart disease are not very well correlated 18

Could high cholesterol (incl LDL) have positive effects? It would seem so 19

Many heart attack patients have normal LDL cholesterol 20

The discussion shifts towards small dense LDL https://www.docmuscles.com/category/cholesterol/ 21

What is it about small dense LDL? 22

Trigs seem to cause increase in small dense LDL particles 23

And Trigs also have an effect on HDL 24

HDL the higher the better? Not true 25

Triglycerides fluctuate http://www.clinlabnavigator.com/lipid-variability.html 26

Lipid ratios 27

There are a few lipid ratios (atherogenic indices) that are commonly used to optimise the predictive capacity of the lipid profile 28

What is a good option? If small dense LDL is the culprit..then we want to know how many small dense LDL particles there are (it is understood that testing for small dense LDL is expensive) TChol tells us, how many LDL particles are there (appr. 2/3 of all cholesterol) Triglycerides correlate with small dense LDL (but fluctuate) HDL doesn t fluctuate so much, but is inversely correlated to Trigs So how about using TChol/HDL as a ratio to gauge the number of small dense LBL particles? and therefore CVD risk? (But keep in mind the possible distortion through ultra-high Trigs and the detrimental effect of ultra-high HDL) 29

Conclusions The Statin debate is a heated one..let s keep an eye on it! Our attention is being drawn to small dense LDL particles The TChol/HDL ratio may at this stage be the most reasonable tool to gauge CVD risk 30

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