Eliminating atherosclerotic cardiovascular disease residual risk

[Eddy Edson]

A succinct review of the "as low as possible as early as possible as long as possible" position for LDL-C/non-HDL-C/apoB: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehad446/7224046

Daniel Steinberg, one of the founders of lipidology and preventive cardiology, noted:

We know that intervention in middle-aged men and women reduces LDL (low-density lipoprotein) levels by 25%–30% and that in a 5- or 6-year trial this reduces hard endpoints of coronary heart disease (CHD) risk by about 30%. Now, the optimist looks at these results and declares a therapeutic triumph; the pessimist looks at the same results and asks, ‘Why aren’t we preventing the other 70% of events?1

Seventy percent of residual risk is unacceptable, because atherosclerosis can be completely prevented in nearly every case if treated early enough and aggressively enough. ‘Residual risk’ is a euphemism for failure to prevent. Myocardial infarctions are potentially 95% preventable; most other sequelae of atherosclerosis are nearly as preventable. Failure should be rare.

There is compelling evidence that atherosclerosis occurs only when LDL particles enter the intimal space, which initiates the inflammatory cascade that is atherosclerosis. If there are no LDL particles in the intima, atherogenesis does not occur.2 This requires keeping circulating LDL-cholesterol (LDL-C) levels low enough (the lower, the better), decreasing them early enough (the earlier, the better), and maintaining them throughout one’s lifetime (the longer, the better), which early detection and modern treatments can readily achieve in nearly every case.3 In 2023, with the available therapies, we might hypothetically say that lipid disorders should be a disease rarely inadequately treated.

 

[Jotheboat]

My vascular specialist told me to keep tight control of your blood sugars, eat well, don't smoke and exercise regularly.
I guess he gave me the end route to the post above without getting technical.

Good post Eddy

 

[JerrySnow]

I've always believed that maintaining a tight control on blood sugar levels is pivotal, not just for those with vascular concerns, but for overall health. Personally, when my blood sugar fluctuates, I notice a huge difference in my energy levels, mood, and even sleep quality. There's also been a lot of discussion recently about the link between blood sugar levels and inflammation, which, as many studies suggest, plays a role in numerous health issues. So, I completely concur with your vascular specialist's advice.