The Older Brother’s oldest son (a.k.a. my nephew Eric) recently annoyed his (morbidly obese) doctor by refusing to take statins after a lab test flagged his total cholesterol as “elevated.”

Some snippets from an email Eric sent me:

The nurse called last night while I was driving home and only gave me my triglycerides and cholesterol readings, followed by the doctor’s (5 feet tall and a good 275lbs) recommendation to take a statin.

After verifying that she heard me correctly that “I’m not going to take a statin” and then informing me that cholesterol can lead to heart disease and stroke, I again declined and told her I would talk further with the doctor, recommending your movie and a couple books.

I called this morning to have the full results faxed to me. After getting that fax from the machine with my greasy, McMuffin-without-the-muffin fingers (didn’t have time to make eggs this morning or a protein shake), I plugged them into excel to share.

Eric is 26 years old and (like his younger brother the Ranger) a strong, muscular guy who’s in excellent shape. Here are the cholesterol numbers that prompted the obese doctor to recommend a statin:

Total Cholesterol: 219

HDL: 61

Triglycerides: 55

LDL: 147

The LDL, of course, is a calculated figure. For those of you who don’t already know, LDL is usually calculated using something called the Freidewald Equation, which looks like this:

LDL = Total cholesterol – (HDL + (Triglycerides/5))

As Dr. Mike Eades explained in one his posts, the Freidewald equation has been shown to over-estimate LDL levels in people whose triglycerides are low. The Freidewald equation also “rewards” you for having higher triglycerides – not something you want — by producing a lower calculated LDL figure. Let’s create a couple of fictional examples to demonstrate:

Patient One

Total Cholesterol: 200

HDL: 45

Triglycerides: 150

Calculated LDL: 125

Patient Two

Total Cholesterol: 200

HDL: 50

Triglycerides: 70

Calculated LDL: 136

The most useful indicator of heart-disease risk you can extrapolate from a lipid panel is the ratio of Triglycerides/HDL. You want that ratio below 2.0, because a ratio below 2.0 is a pretty good indicator that you’re mostly producing large, fluffy LDL. At 3.0 or above, it’s more likely you’re producing small, dense LDL.

Patient One’s ratio is 3.33 — not horrible, but certainly not what I’d consider good, either. Patient Two’s ratio is 1.4 — pretty darned good. Patient Two clearly has a much better cholesterol profile. But because Patient Two’s calculated LDL (which is likely overestimated anyway) is above the supposed magic number of 130, she’s the one who’ll get a lecture from her doctor along with a recommendation to go on a low-fat diet – which will probably reduce her HDL and raise her triglycerides.

Eric’s Triglycerides/HDL ratio is 0.90 … in other words, it’s outstanding. Even if his LDL is really and truly elevated, it’s almost certainly mostly the large, fluffy LDL. That type of LDL not only isn’t dangerous, it protects us against infections and cancer, at least according to Dr. Uffe Ravnskov’s reading of the data.

And yet a doctor wants this strong, active, sports-nut of a 26-year-old man to go on statins because his total cholesterol is 219 and his calculated LDL is 147. If Eric did go on statins, the only beneficiaries would be

Pfizer

The pitchers on opposing softball teams who would no longer have to watch Eric belt their fastballs over the fences

It’s a sad situation when we have to ignore our doctors’ advice in order to stay healthy.