judge holden wrote:
That is an excellent summary of current research. Let me ask you this 1) is regression of atherosclerotic lesions common when ldl is below 100 or is that a rare occurrence? 2) most statin studies involve a 5 year trial and a 30 percent reduction in cv events. Do you think (i am asking for conjecture) that this effect will be magnified when patients are followed over a longer period, especially if a statin is started on a younger person? And finally, how contributory is systolic hypertension under 150 mm, is it of major significance or just background noise relative to ldl cholesterol?
Oh, and can you eat too many nuts?
Whether its common or not is unknown from a scientific perspective, but I suspect its common in those moving from a high LDL to a low one, 100 or below. The fact of the matter is that while Ornish et al was able to show regression using a vegetarian diet with corresponding large reductions in TC and LDL, the only way to really determine if regression has taken place is to do angiography both before and after. Most study subjects don't want to do that merely for the sake of proving a point, particularly with some of the risks involved. And yes, I do believe that the impact of the LRC study design would be magnified over time. Also remember that the effect on blood flow is to the 4th power of the radius. So small reductions in stenosis would have much more impact on blood flow and the manifestation of clinical symptoms (angina for instance). I wouldn't use a statin unless the LDL was quite high, and if so, the individual does not respond favorably to a 10% to 15% fat diet. As far as SBP, its a primary risk factor. The issue is that the chronic high pressure damages the arterial wall, particularly around areas of bifurcation (coronaries, renals, femorals, carotids etc) and denudes the endothelium, the primary barrier to the infiltration of LDL carried cholesterol. The more risk factors one has, and the magnitude of each not only speeds the atherosclerotic process, but the age at which one would be expected to exhibit clinical signs and symptoms. And yes, one can eat to many/much of anything :)