Low 70's, sunny, light breeze and dry as the exceptional weather continues. Happy to have the field. Took down the volume and upped the speed a bit.
Hoka trainers on
stretches, drills, bands, 100m
Hoka Rocket X2s on
3 x 150m w/ 30 sec rest - 24.71, 26.08, 27.40
2 x 150m w/ 30 sec rest - 22.48, 24.74
150m - 22.01
Only 900m total but a little speed. It was plenty hard. HR maxed at 182 1st set, 179 second set, and 167 on the last one.
Staying relatively light, eating more fiber and fruit, and less meat and vegs past few days, mostly because Roya is gone.
Weight is decent, 140.5 after workout
CV Health
Seeing contradictory findings about LDL and CVD, it seems that the technology is improving beyond the standard lipid panel. This study, really a commentary on recent research, says...
There are several subclasses of LDL-C, including large floating (lb), intermediate, and small, dense (sd) LDLs. Recent studies have shown that sdLDL is more atherogenic than other LDL subfractions and that sdLDL-C is a higher-accuracy prognostic biomarker for overall CVD than total LDL-C.... Apolipoprotein B (ApoB), containing lipoproteins of less than 70 nanometers in diameter, can traverse the endothelial barrier, particularly when the endothelium is compromised, where they may become ensnared following interactions with extracellular components such as proteoglycans. Subsequently, they are retained within the arterial wall and further begin a very complex process that ultimately leads to an atheromatous plaque.
There are now tests that are reasonably priced and available called Lipoprotein Fractionation NMR test that utilizes Nuclear Magnetic Resonance (NMR) spectroscopy to give values of these subclasses of LDL. However, the study warns: "further studies are needed to establish a series of standardized methods and guidelines in order to evaluate sdLDL subfractions and properly adjust the current clinical practice."
Affirming this link of sdLDL with CVD in this study discussion:
- The Quebec Cardiovascular Study showed that small LDL subfraction levels were independently correlated with coronary heart disease (CHD) risk in 2072 men over a 13-year follow-up period. Contrariwise, large LDL particles were proven to have no predictive value in this matter.
- Atherosclerosis Risk in Communities (ARIC) and the Multi-Ethnic Study of Atherosclerosis (MESA), proved a directly proportional relationship between small, dense LDL-C levels and the risk for ischemic heart disease.
- Quebec Cardiovascular Study, no relationship with large LDL particles was found.
- The Stanford Five Cities Project and the Physician’s Health Study also proved that a small LDL-C diameter is an important univariate predictor for coronary artery disease (CAD).
Within this study review, some other interesting results:
- We have multiple pieces of evidence to show that lowering the LDL-C beyond the recommended goals can further reduce the number of ASCVD events (heart attacks).
- The Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) study compared the effects of two different doses of simvastatin (20 mg and 80 mg) on 12,064 people who had previously suffered a heart attack in a double-blind trial. After two months, the 80 mg group had a 0.51 mmol/L (19.7 mg/dL) lower LDL cholesterol level than the 20 mg group, but this difference was reduced to 0.29 mmol/L (11.2 mg/dL) after five years. There was a nominal reduction in nonfatal myocardial infarctions in the 80 mg group, but the primary endpoint of major vascular events was reduced by only 6%
- A study published in 2020 by C.D.L. Johannesen et al. prospectively evaluated 108,243 subjects with a median follow-up period of 9.4 years in order to evaluate the correlation between the serum levels of LDL-C and all-cause mortality, and concluded that the association between LDL-C and the risk for all-cause mortality was U-shaped, with both low and high levels associated with an increased risk of mortality the lowest overall risk being observed at an LDL-C concentration of about 140 mg/dL–3.6 mmol/L. (so maybe LDL 150 isn't terrible? But which type!)
- Another prospective study based on a cohort of 14,035 adults aged 18 years and older, with a median follow-up period of 23.2 years (with a mean age of 41.5 years, 51.9% women), noted that both very low and very high LDL-C levels were associated with increased risk of CVD mortality. In particular, very low LDL-C levels were associated with a higher risk of stroke and all-cause mortality
- Other study suggested a link between low LDL-C and stroke, but not clinically confirmed as caused by statin therapies.
Cleveland Clinic posts some values that are helpful in assessing risk from the test result:
However... there are other methodologies for measuring lipid fractionation. Ulta lab offers both. The other is called "Ion Mobility Lipoprotein fractionation"
This
study says it's better:
"Ion mobility appears to provide greater resolution of the pro-atherogenic effects of VLDL than other methodologies"
This LDL fractionation isn't the endall, as Quest states:
" ... based on large population studies showing that people without coronary heart disease tend to have an abundance of large, buoyant LDL particles (pattern A), and people with coronary heart disease tend to have an abundance of smaller, dense LDL particles (pattern B). However, the literature suggests that CVD risk is conferred by a trio of factors that define the atherogenic lipoprotein profile (ALP). The ALP includes elevated small LDL particles (pattern B), low levels of HDL-cholesterol, and often an elevated fasting triglyceride concentration."
UPDATE: I asked Gary about this (heart surgeon), his response:
"I have been aware of small particle LDL as possibly a stronger prognostic indicator of overall cardiovascular risk.
I would encourage you to pursue the measurement of the subclasses of LDL.
While I suspect there is indeed some merit in the notion that the small particle LDL is a more potent instigator of atherosclerotic disease, I am much less sure that diet, exercise and even any of the medications we currently have available can impact (lower) the level of this subclass.
There is ample data, however, to show that getting your LDL-C below 100 (and if you are a diabetic, closer to 70) will lower cardiovascular event risk (heart, stroke). As a cardiac surgeon, I do believe this and have seen positive results in my patients who lower LDL-C...usually with medication as diet and exercise can only do so much when the liver is genetically programmed to churn our LDL-C."
