Friday, June 22, 2012

Diabetes and Dysfunctional Triglycerides

Hypertriglyceridemia is recognized as a causal risk factor for cardiovascular disease. Elevated triglycerides drives a dysfunctional family of lipid problems that increase the risk for developing cardiovascular disease and contribute to the residual risk associated with Statin use. 

Elevated triglycerides also serve as a trigger for assessing other components of of the lipid profile such as non HDL-cholesterol ,Apo B , and small dense LDL measurements .

 I will review components  and treatment of hypertriglyceridemia over the next week and will start by asking you review some of my previous blogs on this subject.

 What is Apo-B ?                                                                                        May 10 2012

     Apo-b is an integral part of each LDL cholesterol particle made in the liver . LDL is responsible for carrying cholesterol to tissues in our body. Apo -b is the key opening the door to various cells in those tissues.

   LDL cholesterol  is the primary tool used to evaluate risk for heart disease. I have discussed some of the problems with LDL measurements in previous post. Dec,11,2011

 Basically LDL Cholesterol is produced in our liver in a spectrum of sizes, from small dense particles to large fatty particles. The size of the LDL particle is effected by Triglyceride levels . Triglyceride levels above  150 mg/dl is associated with an increase in small dense LDL putting a person at  higher risk of cardiovascular disease . 

I will ask you now to find your last lipid panel and do a little math.

 * calculate your LDL by subtracting your HDL and 1/5 of your triglycerides  from your total cholesterol

 * Now add  200 to your triglyceride test result and repeat the calculation. What effect did that have on your LDL cholesterol result ?
contact me at if you have a question

Have Fun , be Smart , do your math
David Calder,MD

May 11. 2012

A better way to evaluate LDL cholesterol

This is a follow up of yesterday post and request that you calculate your LDL cholesterol from your own test results.  My reason for asking you to do the math exercise was to put attention on the fickle nature of the LDL test result  used to evaluate our risk for Cardiovascular disease.

Some of the points to keep in mind are:
   * LDL is usually a calculated number
   * any increase in triglycerides results in a lower appearing LDL and a false sense  of security
   * any increase in triglycerides actually starting at about 100mg/dl is associated with an increase in small
      dense LDL and increased risk of cardiovascular disease.

Is there a better way of evaluating LDL cholesterol ?    Yes
  * Measuring  ApoB is the the easiest, least expensive most consistent way to evaluate LDL Cholesterol.
  * there is one ApoB for each LDL particle regardless of the LDL parcel size.

Treatment guidelines goals
  * American college of clinical endocrinologist ( AACE )
                                        ACCE  LIPID  and Athersclerosis Guidelines
                                        Endocr.Pract. 2012 ; 18 ( supplement 11: 1-78
          Apo B -    < 90 mg /dl in people at risk for cardiovascular disease
                           < 80 mg/dl for people with "established" cardiovascular disease 
                           < 80 mg/dl for patients with diabetes  plus one or more " risk factors "

  * American Diabetes Association  consensus statement on lipid management

          ApoB         < 90 mg/dl  - for people with diabetes  and no other risk factors
                                                - for people without diabetes without cardiovascular disease but with 2
                                                  "risk factors "
                             < 80 mg/dl  - people with "known" cardiovascular disease
                                                   people with diabetes plus one or more additional risk factors

   The official guidelines are catching up with what doctors have been doing for some time , using ApoB test to validate the the accuracy of LDL measurements in predicting risk for cardiovascular disease.

Who are those  "people at risk for cardiovascular disease " and what are those "risk factors" ?
 more tomorrow
Have Fun , Be smart and ask for an ApoB test with your next Lab. evaluation. You do not have to fast for this test.

David Calder, MD
email me at with questions or comments

THURSDAY, MAY 10, 2012

Have you checked your APO-b lately ?

Have fun Be smart look up your last Triglyceride  and LDL test results
David Calder, MD


  1. Of course TG's are ApoB positive, but what's not well known among patients are that TGs will be converted to LDL after they've delivered their loads and that TGs are made from sugars. Your calculation accounts for this, but it's an estimate. This palmative acid in TGs is a saturated fat and is made from the sugars we eat to avoid eating saturated fats. Most ironic.

    Those of us that follow high fat diets do so partially to reduce TGs and reduce our ApoB counts. LDL-C is a notoriously bad estimate of ApoB, especially as LDL particles become larger and fluffier after TG levels are reduced.

    My own TGs have dropped from 131 to 42 on a HFLC diet. It's a pretty consistent n-1 result shared by tens of thousands of anecdotal cases.

  2. The main reason why triglycerides levels increases is due to poor diet and excessive intake of sugar and alcohol, and foods that are rich in carbohydrates. Triglycerides, along with cholesterol, are the lipids or fatty acids deposited in the body. These are developed from the excess calories that are consumed and not able to burn during physical activity.

    what are triglycerides ?


Your comments and questions are appreciated. David Calder,MD