[Rabaja]

This is a very interesting and helpful discussion.

Originally Posted by NHAero

I have a check-up with a new PCP next month and I will … ask for some other tests like ApoB.

Attia favors ApoB over LDL because: (a) it is the protein wrapper rather than the amount of cholesterol it carries that creates plaque risk; (b) there are lipids other than LDL whose wrappers likewise create plaque risk (notably VLDL). This is a sound argument in principle.

I ran this by my PCP who has the kind of preventative mindset that Attia advocates. He replied that his colleagues in the cardiology department (one of the best in the world and a place Attia knows well) don’t use ApoB in most cases since (a) it is highly correlated with LDL, and (b) for the vast majority of patients, even if there is a divergence, doesn’t change the recommended course of action. In other words, it matters in theory but not in practice.

This is a good example to take everything you read with a grain of salt. I really like Attia’s book and find it very useful. But it doesn’t mean that everything he says is the last word. Imho the best way to use the book is as preparation for having an informed conversation with your health care provider. I had that conversation with my PCP, he ordered the ApoB test, we saw that it is highly correlated with my LDL score, and we moved on.

Originally Posted by 5oakterrace

Cyclists often take a few months "off" after the season. Easy stuff. After age 60 I cannot take anything "off."

Same here and I am 10 years younger than you. If I take two weeks off things start to fall apart. Three weeks and I have to dig myself out of a hole.

Originally Posted by 5oakterrace

[T]his is why Attia points to falling as a big risk. 50 percent of folks die in a year after they fall (I am guessing they must be in their 70a or 80s).

“If you are >65, and you fall and break your hip, there is a 30-40% chance you will be DEAD in 12 months.” (Peter Attia)

Originally Posted by reuben

I'll just add that it's possible to go too low. Years ago … I ended up in the hospital, where they discovered … that my total cholesterol was 110. I don't remember the HDL/LDL numbers, but they were so low that my doctor told me that I actually needed more of the bad kind.

Very interesting. My comment was in the spirit of Attia questioning the <100 threshold for LDL in the official guidelines (which a few years ago was lowered from <130). My PCP agrees with Attia and suggests <70 as target. This was in the context of someone who is above (i.e. doesn’t have a risk of going “too low”). If I look at my historical lipid data I see that LDL and HDL are negatively correlated. I.e. the lower LDL goes the higher HDL is, which provides some stability to total cholesterol.