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Cholesterol & Statin Drugs

November 2004

By William Davis, MD, FACC

Statin drugs do indeed help to lower cholesterol and LDL. Nevertheless, cholesterol reduction using a statin agent is far from the final word on reducing heart disease risk, as other risk factors for heart disease, such as low HDL and small LDL particles, are both independent of LDL and far more prevalent than high cholesterol. A number of interesting nutritional strategies are available to address total cholesterol, LDL, low HDL, and small LDL particles. The pattern of low HDL and small LDL particles responds powerfully to weight loss, as well as to treatment with supplements such as niacin and fish oil. These simple approaches will provide a far more effective approach to heart health than a reflex treatment of cholesterol with medication.

Dr. William Davis is an author, lecturer, and practicing cardiologist focusing on coronary disease regression. He is author of the book Track your Plaque, and can be contacted at

Editor’s note: The content of this article and the interpretation of study results are those of Dr. Davis. A consensus has yet to be reached concerning when statin drugs should be prescribed. We published this article because it articulates both sides of this issue very well.

To read our lengthy protocol on preventing atherosclerosis, refer to the Atherosclerosis and Cardiovascular Disease chapter in Life Extension’s Disease Prevention and Treatment book.

Lipoproteins and the VAP™ Test

“My doctor said my cholesterol was fine... So why did I have a heart attack?”

If you want to know whether a heart attack is in your future, knowing your cholesterol level may not be enough.

An excessive quantity of small LDL particles is the most common risk factor contributing to heart-attack incidence in the US—far more common, in fact, than high cholesterol. It is a hidden danger that can be uncovered only when measured specifically. You can have small LDL particles with high, low, or in-between levels of cholesterol. Small LDL particles triple the risk of heart attacks. When they occur alongside other abnormalities, such as high total cholesterol or high C-reactive protein (a measure of inflammation), the risk of heart attacks increases sixfold.62

Small LDL particles are a far more destructive force than their larger counterparts. They are like finely tuned weapons designed to wreak maximum damage. Smaller particles are better able to penetrate the cellular barrier and be deposited in the artery walls, creating atherosclerotic plaque. They also persist longer in the circulation, giving them greater opportunity to cling like little magnets to tissues within the arterial walls. Once residing in the arterial wall, small LDL particles are more prone to oxidation, stimulating the release of inflammatory and adhesive proteins.63

The growing recognition of small LDL particles as a common and potent hidden source for heart disease has led to the availability of specialized tests from several laboratories. Life Extension is now making one such technology available through its VAP™ (Vertical Auto Profile) test. VAP™ is a method of separating blood proteins into component lipoproteins, or lipid-carrying proteins. Dr. Jere Segrest, director of the Atherosclerosis Research Unit at the University of Alabama-Birmingham, developed the test, which reveals much more than simple cholesterol panels.

After you submit your blood for testing, a VAP™ report will be returned to you. LDL particle size is reported in a readily understandable format as pattern A (the less harmful large LDL) or pattern B (the dreaded small LDL). Intermediate-sized LDL particles are reported as pattern A/B. Pattern B poses maximum risk; pattern A/B poses an intermediate level of risk.

What does having pattern B, or an excess of small LDL particles, tell you? This one measurement holds a world of information. Not only is your risk for heart attacks three to six times higher, but also you are more resistant to insulin and more likely to develop the metabolic syndrome or even diabetes if you become overweight.64 It also tells you that a low-fat diet (deriving less than 20% of total calories from fat) may paradoxically heighten your risk for heart disease.65

Knowing that you are pattern B also points you toward treatment strategies that can effectively correct this hidden source of risk. Small LDL is very responsive to niacin (vitamin B3) treatment, usually disappearing with doses of 500-1000 mg per day (though long-term treatment will be necessary). Weight loss can be a very powerful treatment strategy if you are overweight. Fish oil in doses providing at least 1400 mg of EPA and 900 mg of DHA per day helps by reducing triglyceride levels, a necessary ingredient to create small LDL particles. Dietary strategies that slow or reduce sugar release (i.e., lower glycemic index) can be helpful, including eating high-fiber foods or supplements such as flaxseed, glucomannan, oat bran (beta-glucan), psyllium seed, raw nuts like almonds and walnuts, and the starch blocker white bean extract.

The VAP™ panel directly measures LDL. Many people are surprised to learn that the LDL reported to you by your doctor or hospital is calculated, not measured, and is commonly inaccurate by 30% or more.66 Lipoprotein tests like VAP™ can be crucial, and perhaps lifesaving, for people who have already been diagnosed with coronary or vascular disease. It is not uncommon for heart-attack victims to have normal cholesterol levels and be told that there is no identifiable cause for their disease. VAP™ testing uncovers one, if not several, hidden risk factors in over 90% of people with heart disease.

The information provided through VAP™ lipoprotein testing provides far greater insight into heart disease risk factors than that offered by standard cholesterol testing, which will enable you to take greater control over your risk of heart disease.

The full VAP™ test measures:

Direct Measured Lipids
• Low-density lipoprotein
• High-density lipoprotein (HDL)
• Total very low-density
lipoprotein (VLDL)
• Total cholesterol
• Triglycerides

Targets of Therapy
• Non-HDL cholesterol
• Probable metabolic

Risk Factors
• Lipoprotein(a)
• Remnant lipoprotein
(IDL + VLDL 3)
• LDL density pattern

Clinical Considerations
• HDL-2
• HDL-3
• Total HDL
• VLDL 1+2
• VLDL 3
• Total VLDL
• Intermediate-density
lipoprotein (IDL)
• Total cholesterol/HDL ratio

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