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HDL “good” Cholesterol is hard to alter

Total Cholesterol (TC), LDL-Cholesterol (Bad cholesterol), and HDL-Cholesterol (good cholesterol, are measures of lipid levesl in the blood. Which level should you focus on?

If the TC is >5 mmo/l, then think about the risk. But better is the ratio of TC :HDL. If that is >5:1 then you should worry. It should be lower, ideally <4:1.

Statins lower TC and LDL. That is good. And statins seem to do good in most people. The new NICE guidelines suggest that if your risk of heart disease over 10 years is >10%, then a statin should be considered.

Sometimes the issue is a very low HDL. Statins are not so good for that. Fibrates can do that, with some evidence that they could reduce heart attack rates, BUT NOT death rates and ONLY if not on a statin. Specific CETP inhibitors raise HDL, but appear to have NO BENEFIT at all, and one of them increased death rates.

Research by Dr Keene in my hospital suggests thatit is statins that should be considered 1st, and the others only after that- the others might affect the blood levels, but not what is important- death and heart attack rates.

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g4379 (Published 18 July 2014)
Cite this as: BMJ 2014;349:g4379

Posted on 07 December 2014
Author: LCC
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