LDL is a poor predictor of cardiovascular risk

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Paul Saladino14m · 2022-07-16

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26

Claims Supported

20

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77%

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20 of 26 claims supported

20 supported6 partial / not

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Well SupportedFasting insulin levels, ideally below 5 and preferably below 3, are crucial for assessing insulin sensitivity.Not SupportedFocusing solely on LDL cholesterol as the sole indicator of cardiovascular risk is a poor predictor.Well SupportedIncreased overall saturated fat intake generally leads to higher LDL levels, although some saturated fats like stearic acid may not.Well SupportedElevated LDL cholesterol with large, buoyant lipid particles is not indicative of a problem in the context of high insulin sensitivity.Well Supported

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A. Volkovreader

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Bookmarking — the dossier-vs-overview split is the right call. Most of the time I want overview; sometimes I want receipts.

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Would love a "what would change this verdict" RSS feed. Sign me up if it exists.

Paul Saladino maintains low hs-CRP, fibrinogen, and fasting insulin, suggesting no excess glycation or endothelial damage despite high carbohydrate intake.

Well SupportedIf an individual is insulin sensitive (fasting insulin < 5, preferably < 3), then LDL particle number, LDL size, and Lp(a) are less concerning for cardiovascular risk.

Well SupportedKetogenic diets lead to a decrease in triglycerides and an increase in HDL, improving the triglyceride to HDL ratio.

Not SupportedBeing myopically focused on LDL can lead to unnecessary statin prescriptions and removal of nutrient-rich foods.

Well SupportedHyperinsulinemia is an independent risk factor for ischemic heart disease.

Well SupportedThe context of lipid profiles, including HDL, Lp(a), ApoE4, and uric acid, is crucial for interpreting LDL's role in cardiovascular disease.

Well SupportedHigh HDL and low triglycerides are not strongly associated with atherosclerosis.

Well SupportedA triglyceride to HDL ratio of approximately 1.5 distinguishes between large, buoyant LDL and small, dense LDL.

Well SupportedIn the Framingham study, individuals with the highest HDL levels showed no significant relationship between LDL cholesterol and cardiovascular risk.

Partially SupportedHyperinsulinemia is an independent risk factor for ischemic heart disease, predicting it better than LDL cholesterol.

Partially SupportedEating saturated fat raises LDL cholesterol, while eating seed oils lowers LDL but raises Lp(a) and oxidized LDL.

Partially SupportedInsulin sensitivity may prevent a Pattern B LDL lipid profile even with a poor diet.

Partially SupportedA rise in LDL cholesterol on an animal-based diet with carbohydrates is primarily due to low carbohydrate intake and lipid metabolism according to lipid energy models.

Partially SupportedA large number of LDL particles can lead to flags for increased small dense LDL, regardless of actual particle size distribution.

Partially SupportedLDL cholesterol levels can be highly variable and are affected by diet and fasting status.

Partially SupportedSaturated fat may contribute to higher LDL cholesterol levels.

Partially SupportedThe speaker's LDL levels have been in the 120s-140s and recently 164 while consuming carbohydrates and fruit.

Partially SupportedVery low carbohydrate diets (less than 100g/day) can lead to LDL levels of 300-400 mg/dL, and increasing carbohydrate intake can lower these levels.