The Role of Small, Dense LDL in Atherosclerosis: A Hidden Risk Factor

Dr. Kumar’s Take:

This recent review highlights a crucial but often overlooked risk factor for heart disease: small, dense low-density lipoprotein (sdLDL). Unlike regular LDL cholesterol, sdLDL particles are more likely to penetrate artery walls, oxidize, and trigger plaque formation. The paper emphasizes that even individuals with normal LDL levels may still be at risk if their sdLDL levels are elevated. Measuring sdLDL could improve cardiovascular risk assessment and help tailor treatment strategies.

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LDL Cholesterol: Finding the Right Balance for Heart Health

Dr. Kumar’s Take

This study looked at how different levels of LDL cholesterol affect our chance of dying from any cause and from heart-related problems. It found that having very low or very high LDL can be risky, but in different ways.

• Very low LDL (<70 mg/dL) was linked to a higher risk of strokes and overall heart-related deaths (cardiovascular mortality).
• Very high LDL (≥190 mg/dL) was linked to a higher risk of heart disease (CHD) and overall heart-related deaths, but it did not show an increase in deaths from any cause (all-cause mortality).

In other words, both very low and very high LDL levels increase the risk of heart problems. However, very high LDL does not increase the overall chance of dying when compared to moderate LDL levels.

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Should You Take a Statin if Your LDL is High on a Low-Carb Diet?

Dr. Kumar’s Take:

This study challenges the long-held belief that LDL-C (low-density lipoprotein cholesterol) is always harmful. The authors argue that in the context of a low-carbohydrate diet (LCD), high LDL-C may not be a sign of increased cardiovascular disease (CVD) risk. Instead, they suggest looking at other markers—such as insulin resistance, triglyceride-to-HDL ratio, and coronary artery calcium (CAC) score—before deciding whether statins are necessary.

For those on an low carbohydrate diet with high LDL-C but otherwise good metabolic markers (low triglycerides, high HDL), this study suggests that statins may not provide the same benefits as they do for those with high LDL-C caused by poor diet and metabolic disease.

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