6

votes

If cholesterol is not a good predictor of heart disease risk, what is a good predictor?

Answered on August 19, 2014
Created May 10, 2012 at 1:29 AM

What does the latest science say about how to best predict the risk of heart disease? Total cholesterol doesn't appear to be a good predictor. People discuss triglyceride levels and also the ratios of various numbers. What lab tests are the best predictors and what numbers should one desire?

Medium avatar

(10611)

on March 08, 2013
at 04:46 PM

That is one of the major factors in the Framingham equation. Being female has an even stronger effect on reducing risk.

Medium avatar

(10611)

on March 08, 2013
at 04:46 PM

That is one of the major factors in the Framingham equation. Being female has an even stronger effect on reducing risk.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on February 09, 2013
at 11:56 PM

I think both of those may be pretty accurate. Erectile potency has shown strong correlations with cardiovascular disease. Interesting also that viagra was originally intended to treat high blood pressure and complications of heart failure. Easier to test your erection than your cholesterol too.

Medium avatar

(10611)

on May 11, 2012
at 01:29 AM

I've been under a lot of work-related stress over the last 2 months. Lots of new stuff to learn, 12 hour days and lots of random night shifts. Guess what? My resting systolic blood pressure is up 30 points. All psychological. My diet and exercise have not changed.

Medium avatar

(10611)

on May 10, 2012
at 11:30 PM

Over time I've learned to manipulate my HDL and systolic blood pressure to reduce my CV risk. If there are better tests I would learn to manipulate them but I don't think I would drop off practices which improve the other ones.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on May 10, 2012
at 11:19 PM

related article: whilst looking in to the hs-crp test, i found this article; "CAC score and hs-CRP improve risk prediction over Framingham risk score" http://www.theheart.org/article/1201043.do

543a65b3004bf5a51974fbdd60d666bb

(4493)

on May 10, 2012
at 11:16 PM

whilst looking in to the hs-crp test, i found this article; "CAC score and hs-CRP improve risk prediction over Framingham risk score" http://www.theheart.org/article/1201043.do

Medium avatar

(10611)

on May 10, 2012
at 03:57 PM

I do not say that the Framingham risk score is the be all and end all @talldog. My risk is 5% of a CV event in the next 5 years. I know I can change it significantly by raising my HDL and lowering systolic blood pressure, but I can't change the other factors. Regarding France, I lived there for over a year. I walked all the time, ate anything I felt like, lost 25 lbs, and improved my CV risk score (lower blood pressure and higher HDL). I think the walking did it. But maybe it was all that high gluten bread.

11b7b7ba720a5cd43c74a0ef99a16adb

(3448)

on May 10, 2012
at 03:13 PM

Plug the typical Frenchman into that calculator, and it would say he's a dead man walking, despite the fact that the French have one of the lowest rates of CHD in the world (and not, it's not because of the red wine, otherwise the Italians would also have low levesl of CHD--they don't).

11b7b7ba720a5cd43c74a0ef99a16adb

(3448)

on May 10, 2012
at 03:11 PM

+1 for Colpo's book "The Great Cholesterol Con." There is not one reason for CHD (nor one magic bullet to prevent it, or a magic marker to monitor), but if you had to key in one one thing it would be stress. Emotional stress or physical stress (overwork, disease & infection, lack of sleep, a hurried lifestyle). He also points out that iron blood levels are also important (but hard to change).

A968087cc1dd66d480749c02e4619ef4

(20436)

on May 10, 2012
at 01:54 PM

Smoking. Diabetes. High blood pressure. Obesity. Ratio of triglycerides to HDL over 2. Prior heart attack. Age/race/gender. Stress. Inflammation. Family history. Ancel Keys and T. Colin Campbell. (Okay, just checking to see if you were still paying attention.)

Medium avatar

(10611)

on May 10, 2012
at 12:16 PM

Overeating paleo would also do the trick.

Medium avatar

(10611)

on May 10, 2012
at 12:13 PM

I've heard that CRP is most useful for people who have already had a CV event. If hs-CRP is useful for everyone that's a real advance.

3327924660b1e2f8f8fc4ca27fedf2b2

(2919)

on May 10, 2012
at 12:01 PM

+1 for oxidized ldl.

F5f742cc9228eb5804114d0f3be4e587

(7660)

on May 10, 2012
at 04:50 AM

Eating the SAD seems to do the trick.

D3f3b91d1dd9ce60865654faeb2ec809

on May 10, 2012
at 04:08 AM

Death is a pretty reliable one.

35b2cb4d450e5288895c255dfdfff35d

(5828)

on May 10, 2012
at 03:05 AM

Thanks very much!

8496289baf18c2d3e210740614dc9082

(1867)

on May 10, 2012
at 01:54 AM

Spot on in both counts.

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10 Answers

6
64433a05384cd9717c1aa6bf7e98b661

(15236)

on May 10, 2012
at 01:34 AM

3327924660b1e2f8f8fc4ca27fedf2b2

(2919)

on May 10, 2012
at 12:01 PM

+1 for oxidized ldl.

8496289baf18c2d3e210740614dc9082

(1867)

on May 10, 2012
at 01:54 AM

Spot on in both counts.

5
34cf7065a6c94062c711eb16c0f6adc3

on May 10, 2012
at 04:04 AM

Arterial plaque is probably the best determinant. The heartbeat gives a good idea of it. Basically the distance and peaks of systolic and diastolic beats. There was one article by Peter on it. http://high-fat-nutrition.blogspot.in/2010/01/who-pays-piper-for-arterial-stiffness.html

You can also measure your calcium score, as calcium is the more common deposit in the arteries.

Oxidized LDL as already mentioned, but it is only a secondary indicator.

4
2b3edde3c7b9393fe36a2dd9c8acf473

on May 10, 2012
at 06:03 AM

The triglyceride:HDL ratio is a good indicator. A number <1 is pretty good, although 0.5 would be great. A ratio of 3 or 5 and you're in trouble.

2
1edb06ded9ccf098a4517ca4a7a34ebc

on February 09, 2013
at 09:58 PM

If your a male, my guess is that a good guide is the strength of your erection and your capacity for exertion.

A2c38be4c54c91a15071f82f14cac0b3

(12682)

on February 09, 2013
at 11:56 PM

I think both of those may be pretty accurate. Erectile potency has shown strong correlations with cardiovascular disease. Interesting also that viagra was originally intended to treat high blood pressure and complications of heart failure. Easier to test your erection than your cholesterol too.

2
1d02c0c2fa9946de88d8f24e81ca1cf6

on May 10, 2012
at 12:44 PM

Dear old Anthony Colpo often stresses the importance of getting serum ferritin levels checked. See for e.g http://stroke.ahajournals.org/content/35/2/453.full.pdf I suspect the literature is not clear-cut but worth thinking upon.

11b7b7ba720a5cd43c74a0ef99a16adb

(3448)

on May 10, 2012
at 03:11 PM

+1 for Colpo's book "The Great Cholesterol Con." There is not one reason for CHD (nor one magic bullet to prevent it, or a magic marker to monitor), but if you had to key in one one thing it would be stress. Emotional stress or physical stress (overwork, disease & infection, lack of sleep, a hurried lifestyle). He also points out that iron blood levels are also important (but hard to change).

Medium avatar

(10611)

on May 11, 2012
at 01:29 AM

I've been under a lot of work-related stress over the last 2 months. Lots of new stuff to learn, 12 hour days and lots of random night shifts. Guess what? My resting systolic blood pressure is up 30 points. All psychological. My diet and exercise have not changed.

2
543a65b3004bf5a51974fbdd60d666bb

(4493)

on May 10, 2012
at 12:05 PM

Have a look in to the hs-CRP (High-sensitivity C-reactive protein) test. There looks to be a fair bit of research &/or studies involving this test.

People with higher hs-CRP values have the highest risk of cardiovascular disease, and those with lower values have less of a risk. Specifically, individuals who have hs-CRP results in the high end of the normal range have 1.5 to 4 times the risk of having a heart attack as those with hs-CRP values at the low end of the normal range.

The American Heart Association and US Centers for Disease Control and Prevention have defined risk groups as follows

Low risk: less than 1.0 mg/L
Average risk: 1.0 to 3.0 mg/L
High risk: above 3.0 mg/L

These values are only a part of the total evaluation process for cardiovascular diseases. Additional risk factors to be considered are elevated levels of cholesterol, LDL-C, triglycerides, and glucose. In addition, smoking, having high blood pressure (hypertension), and being diabetic also increase the risk level.
Source.

543a65b3004bf5a51974fbdd60d666bb

(4493)

on May 10, 2012
at 11:19 PM

related article: whilst looking in to the hs-crp test, i found this article; "CAC score and hs-CRP improve risk prediction over Framingham risk score" http://www.theheart.org/article/1201043.do

Medium avatar

(10611)

on May 10, 2012
at 12:13 PM

I've heard that CRP is most useful for people who have already had a CV event. If hs-CRP is useful for everyone that's a real advance.

2
760dc4c895bffafaa2812cc45952d124

on May 10, 2012
at 04:29 AM

Homocysteine levels also matter:

http://en.wikipedia.org/wiki/Homocysteine

1
800e726cb5dff569fd8edf604c3e2793

on March 08, 2013
at 04:17 PM

The best -- by far -- predictor of CVD is age :-(

Medium avatar

(10611)

on March 08, 2013
at 04:46 PM

That is one of the major factors in the Framingham equation. Being female has an even stronger effect on reducing risk.

Medium avatar

(10611)

on March 08, 2013
at 04:46 PM

That is one of the major factors in the Framingham equation. Being female has an even stronger effect on reducing risk.

1
Medium avatar

(10611)

on May 10, 2012
at 11:25 AM

Do you know your Framingham risk?

http://hp2010.nhlbihin.net/atpIII/calculator.asp?usertype=prof

Play with "what if" scenarios to see how to lower your risk.

Medium avatar

(10611)

on May 10, 2012
at 11:30 PM

Over time I've learned to manipulate my HDL and systolic blood pressure to reduce my CV risk. If there are better tests I would learn to manipulate them but I don't think I would drop off practices which improve the other ones.

Medium avatar

(10611)

on May 10, 2012
at 03:57 PM

I do not say that the Framingham risk score is the be all and end all @talldog. My risk is 5% of a CV event in the next 5 years. I know I can change it significantly by raising my HDL and lowering systolic blood pressure, but I can't change the other factors. Regarding France, I lived there for over a year. I walked all the time, ate anything I felt like, lost 25 lbs, and improved my CV risk score (lower blood pressure and higher HDL). I think the walking did it. But maybe it was all that high gluten bread.

11b7b7ba720a5cd43c74a0ef99a16adb

(3448)

on May 10, 2012
at 03:13 PM

Plug the typical Frenchman into that calculator, and it would say he's a dead man walking, despite the fact that the French have one of the lowest rates of CHD in the world (and not, it's not because of the red wine, otherwise the Italians would also have low levesl of CHD--they don't).

543a65b3004bf5a51974fbdd60d666bb

(4493)

on May 10, 2012
at 11:16 PM

whilst looking in to the hs-crp test, i found this article; "CAC score and hs-CRP improve risk prediction over Framingham risk score" http://www.theheart.org/article/1201043.do

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