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barnacsyesterday at 5:32 AM1 replyview on HN

It turns out LDL has different subfractions based on size. Normally, the liver produces large ones which shuttle fat around the bloodstream, lose their payload and shrink then the liver reabsorbs them and the cycle continues.

The problem appears to begin when these LDL molecules hang around for too long. They are damaged by external factors in the bloodstream (eg. glycation due to high blood glucose, oxidation due to fragile polyunsaturated fats) and not recognized anymore for recycling. That's when they can start forming macrophages.

tl;dr LDL by itself is an incorrect measure of cardiovascular risk. Big pharma still profits by selling everyone LDL reducing drugs.

one authentic source: https://www.youtube.com/watch?v=fVLZA0qp-wc


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grep_nameyesterday at 7:11 AM

I have heard this too, and that cholesterol measurements are flawed because they don't account for particle size. That you can actually have better 'numbers' but worse results, if you reduce particulate size but also overall volume. It's frustrating that the science behind cholesterol is constantly in wild flux, but at any discrete moment you're expected to accept whatever the momentary consensus is.

Interestingly, my dentist, who also has a bit of a fixation on cholesterol on a personal level and is educated on the matter, has said that a heart calcium scan is the best way to determine what someone's target cholesterol number should actually be, and that it should not be the same from person to person.

This was after I voiced my frustration to him at having made lifestyle changes to get my cholesterol down in order to avoid getting put on statins (not wanting yet another daily drug if I can avoid it), getting the my number below the target of 110, only to shortly after that find out that they'd lowered it to 70. I talked to my endocrinologist about it, and she basically said "yeah, those numbers are more-or-less unachievable. But we want to be extra careful for type 1 diabetics, so we hold them to a higher standard. Either way, everyone gets put on statins at some point anyway, so who cares?"

I'm absolutely allergic to "everyone goes on x medication, so stop whining and go on x medication" as a medical argument, and will probably just deal with being labelled non-compliant over this one unless my cholesterol reaches a level I actually personally find to be too high at this point. Which sucks to have to do, but hey, it's my body after all, and so far doctors have failed to make a convincing case for me personally here.

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