What you need to know about Cholesterol !
So far all patients were getting their yearly lipid panel done and if they have slightest elevation of their LDL cholesterol, their provider will put them on statins. It is a wrong approach and can result in significant risk of multiple side effects due to statins. In our practice we further evaluate a patient's risk by doing a breakdown of the particle size. I am sure people are aware of the fact that 15% of all heart attacks occur in patients with normal LDL cholesterol, so one may ask, what did we miss so far in evaluating the risk for heart disease and stroke.
Atherosclerosis is caused by many factors besides cholesterol and it is important to evaluate a patient as whole rather than just one number. It is important to understand that inflammation is the event which start the process of atherosclerosis, whether inflammation is initiated by smoking, diabetes or some other factors such as genetics, it will all results in release of chemicals called as cytokines, which lead to migration of anti inflammatory cells called as macrophage to the lining of the arteries. These cells then engulf only small LDL particles which then get deposited into the lining and then this “Plaque” gets calcified. People who have large LDL particles tend not to form a plaque as large particles can’t enter into macrophages. In our practice, we, now, routinely check C-Reactive Protein, NMR lipo, Homocysteine levels and based on the results, we further screen our patients. So treating everyone with high LDL cholesterol is a wrong approach, one must look at further breakdown of the particle sizes of LDL Cholesterol before starting someone on statins and other lipid lowering drugs.
This indiscriminate use of statins is resulting in more illnesses, pharmaceutical companies are happy to sell them to you but patients need to get educated themselves and ask more questions. Now with the arrival of ChatGPT, getting information is very easy, so it might be useful to spend some time everyday to ask questions. I use these tools everyday, even in the exam room to help me treat my patients with better hands-on information. I use Uptodate, ChatGPT and Consensus on a daily basis to keep myself well informed.