Paul Saladino· MD
a higher HDL group is probably more insulin sensitive and what did he find he found that as you go up an LDL number according to the Framingham data if your HDL is high there is no increase in cardiac risk
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a higher HDL group is probably more insulin sensitive and what did he find he found that as you go up an LDL number according to the Framingham data if your HDL is high there is no increase in cardiac risk
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if I went traditional doctor they would look at this and fall out of their seat completely missing the fact that my HDL is 95 and my triglycerides are 46 you know like show me someone like I just don't believe that with that amount of insulin sensitivity any human is going to develop atherosclerosis
if you break it down by HD on you take one line it's the same data and you separate it into four lines what you find is the people with the highest level of HDO presumably people who have an indication of insulin sensitivity have essentially no correlation between LDL and cardiovascular disease while those with high HDL or CV low HDL have a curve that's much steeper and there is a very good correlation between LDL and cardiovascular disease
there is no correlation in the Framingham study when we stratify by L HDL when LDL Rises there is no increase in cardiovascular disease risk if HDL is high as a proxy for insulin sensitivity again triglyceride to HDL ratio would be a better proxy but in terms of that metric and a Framingham study which I've done in my book I stratified them all and show you that there is a difference there there is no correlation
if you stratify the connection between LDL and cardiovascular disease by HDL level which is a pretty good proxy for insulin sensitivity what you find is that at the highest levels of HDL 65 and 85 milligrams per deciliter there is essentially no correlation between LDL levels and cardiovascular disease
while those with high HDL, excuse me, low HDL, have a curve that's much steeper and there is a very good correlation between LDL and cardiovascular disease.
But if you break that cohort down by HDL, right? If you break it down by HDL and you take one line, it's the same data, and you separate it into four lines, what you find is that the people with the highest level of HDL, presumably people who have an indication of insulin sensitivity, have essentially no correlation between LDL and cardiovascular disease
if you look at cohorts of people framing ham and hanes and if you stratify those cohorts by some metric that gives you a sense of insulin sensitivity whether that's hdl fasting insulin triglycerides whatever all of those might give you a sense of insulin sensitivity aka metabolic dysfunction you see the risk of ldl and heart disease essentially vanish or is massively attenuated
so for instance in the framingham cohort if you have a low hdl which is a proxy for insulin resistance then ldl tracks very well with cardiovascular disease but if you have an hdl of 65 or 85 most of those people are pretty freaking insulin sensitive milligrams per deciliter there's essentially no relationship or a massively attenuated relationship between ldl and cardiovascular disease
when you stratify ldl versus heart disease risk by a third variable that is correlated with insulin resistance and or insulin sensitivity you see a very different relationship emerge whereas there's essentially no correlation between ldl level and cardiovascular disease
those who have the highest HDL above 65 milligrams per deciliter essentially show no relationship between levels of LDL and cardiovascular disease while those with the lowest HDL show a very strong relationship suggesting that there is a third variable at play which I would say is clearly insulin resistance AKA sensitivity
if you break that framing hand data into four lines based on your HDL level those who have the highest HDL above 65 milligrams per deciliter essentially show no relationship between levels of LDL and cardiovascular disease
if you break that framingham data into four lines based on your hdl level those who have the highest hdl above 65 milligrams per deciliter essentially show no relationship between levels of ldl and cardiovascular disease while those with the lowest hdl show a very strong relationship suggesting that there is a third variable at play which i would say is clearly insulin resistance aka sensitivity
if you stratify the Framingham data by HDL what you see is a vastly different correlation between LDL and incident cardiovascular disease look at this top one if you have a low HDL the majority of these people are going to have metabolic syndrome
if you look at the overall Framingham data of um cardiovascular disease increasing an instance of cardiovascular disease on the y-axis ldlc on the x-axis and you don't stratify by any metric that is that is associated with insulin resistance you get a straight line
in this small cohort of people who are insulin sensitive there's essentially no relationship between LDL cholesterol and cardiovascular disease