Background I recently had the opportunity to meet a medical hero of mine at the Stanford University faculty club. Gerald “Jerry” Reaven is the renown endocrinologist and researcher (pictured with me) who coined the term metabolic syndrome and is author of Syndrome X: The Silent Killer. I owe him my life given that his metabolic syndrome criteria helped identify my own underlying risk for heart disease and chronic disease. Something the cholesterol guidelines and archaic Framingham risk calculator (old version and newer version) would have missed. See my prior post on the new guidelines. His research has also inspired me to devote my medical practice to the care of high risk Asian Indians and now even East Asians who are plagued by an epidemic of insulin resistance characterized by metabolic syndrome. Global heart disease is predominantly driven by metabolic syndrome, an insulin resistant condition which has nothing to do with the LDL result you…
Read MoreA Closer Look at the New Cholesterol Guidelines
Old Cholesterol Guideline Theme: It’s All About Your LDL Number When clinical guidelines come out, there are two major levels at which they’re interpreted. The first interpretation is literal, following the guidelines to a tee. However the more important interpretation is the guideline theme. Most docs forget about the specific details over time and apply the general message to their practice. The prior cholesterol guidelines morphed into the following thematic messages: 1. LDL is bad and the higher your LDL level, the greater your risk of heart disease. 2. The higher your individual risk, the lower your LDL target. For example, let’s drop LDL to less than 70 mg/dl in patients with existing heart disease. Not because there’s evidence to do so, but because we’re making an assumption that lower is better. 3. Since LDL is evil and lower LDLs are better, it is ok to use multiple medications to reach…
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