JimBG wrote:3) Dave's energy model and his resultant thinking that LDL particle counts do not matter seems to be limited to a subset of individuals who are lean mass hyper responders.
I understand his argument much differently. He starts from the observation that cardiovascular risk tracks much better with triglycerides and HDL than it does with LDL. If you look at LDL in a vacuum, there's a weak relationship, but once you add trigs and HDL the relationship disappears and reveals LDL by itself as nothing more than a surrogate for high trigs and low HDL. These analyses come from the same datasets, MESA, WHI, etc. etc. If you look at trigs, HDL, and LDL together, you see that LDL doesn't affect CVD risk. Only if you ignore trigs and HDL does LDL appear to matter.
This leads to two obvious questions:
1. Why would we manipulate LDL when all of the CVD risk actually goes with trigs and HDL?
2. How do we live in such a way as to bring our trigs into double digits and our HDL into high double digits?
Those are the key issues.
Now, the low CVD risk group with low trigs and high HDL can be divided into two subgroups. Most people in this group have low LDL; a smaller subgroup has high LDL. The latter group gets flagged by the LDL guidelines and is told by primary care doctors to take statins. This is the group Dave identifies as Lean Mass Hyper Responders (LMHR).
The analysis of LDL against all cause mortality (ACM) is just an additional source of comfort for those in the LMHR group. It's not central - the core point remains that LDL is not correlated with CVD risk if you include trigs and HDL in the statistical analysis.
And who also have naturally high HDL C and low Trigs.
In 2003 my trigs were 373 and my HDL was 36 for a ratio of 10.36. The results were so bad that I didn't visit the doctor for six years.
Since 2009, six months after I began my journey back to good health, I have tested lipids nine times, and that ratio has varied from 0.33 to 1.10. I am far from alone in learning that intermittent fasting, avoiding processed food and seed oils, and exercising can make a huge difference in that CVD risk marker. For many people, attaining a low trigs/HDL ratio is a lifestyle choice.