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<p>The best answer I’ve seen (from a doctor, BTW) is that you will not be able to influence your doctor’s thinking on this issue and that “providing ammo”, in most cases, is a waste of time. If you decided to go against the doc, then you politely accept the prescription and don’t fill it.</p>
<p>Having said that, I would not advise anyone to ignore their doc on cholesterol testing unless they have done all the research and made a very informed decision based on their total profile. There are a lot of cases where high LDL (or high cholesterol) means a very high risk of coronary disease and should be treated. There are other cases where moderately high LDL or total cholesterol doesn’t mean high risk. You’ve got to look at it int the context of HDL numbers, triglyceride numbers, and (ideally) LDL particle counts or ApoB.</p>
<p>The most convincing guy on this stuff is a doc named Thomas Dayspring:</p>
<p>[LDL</a> Cholesterol vs. LDL Particle Number, LDL-P and ApoB Measurements - YouTube](<a href=“http://www.youtube.com/watch?v=LUlJE2Rqs0w]LDL”>http://www.youtube.com/watch?v=LUlJE2Rqs0w)</p>
<p><a href=“http://www.lipidcenter.com/pdf/Understanding_the_Entire_Lipid_Profile.pdf[/url]”>http://www.lipidcenter.com/pdf/Understanding_the_Entire_Lipid_Profile.pdf</a></p>
<p>He believes that the real underlying risk factor here is a having a large number of LDL particles stamming into your artery walls. A crude measure cholesterol (and estimated LDL cholesterol) was used because it was the only test available. But, if Dayspring is right, high LDL with low LDL particle counts isn’t risky at all Conversely, low LDL and high LDL particle counts is incredibly high risk.</p>
<p>He’s an interesting guy as far as statin drugs. When he sees high particle counts, he turns to statin drugs and combinations of drugs immediately to lower them. On the other hand, he is very aware of the dietary profiles that may produce high LDL cholesterol numbers, but low particle counts (and usually high triglycerides, high HDL) and would not be pushing statins in those cases.</p>
<p>If I had high total cholesterol or high LDL cholesterol, I would get the LipoProtein NMR test (or an ApoB test), even if I had to pay for it out of pocket ($129) to find out conclusively whether I also had large number of LDL particles or not.</p>
<p>There are several probably inter-related measures that will help assess risk (except in the case of certain genetic factors that push LDL and LDL particle counts through the roof). HDL and HDL to LDL ratios is one. The other is triglycerides to HDL ratio. Low triglyclerides and high HDL tend to go together and tend to indicate low coronary risk, even with moderately high LDL (except for certain genetic conditions). Conversely, high triglycerides and low HDL tend to indicate higher coronary risk, even if the LDL is low (perhaps due to statin drugs).</p>
<p>This is a very difficult topic to sort out. Lipitor is the biggest selling drug in the history of the pharmaceutical industry, thanks in no small part to astronomical amounts of marketing dollars spent on making sure that the cholesterol test and lowering cholesterol numbers is the end all and be all. There’s no question in my mind that these cholesterol lowering drugs are overprescribed. That, however, doesn’t mean that they aren’t appropriately prescribed in many cases.</p>