Moderators: JeffN, carolve, Heather McDougall
" Clearly if the goal is to prevent CVD events it is important to limit both SFA & cholesterol to lower nonHDL-C and to limit salt to lower BP. The ASCVD** calculator is calculating the risk of atherosclerotic CVD events. Clearly most Americans eat so much SFA and cholesterol that is the most common CVD event in the USA, which is CAD. But ASCVD or atherosclerotic CVD is not the same as risk for CVD events and in populations that eat a lot of salt but not much SFA and cholesterol most CVD events are not atherosclerotic. For example, in Japan in the 1970s ASCVD was very low and yet deaths from hemorrhagic stroke and heart failure were very high. Stroke was the #1 killer of Japanese back then and may still be today although stroke deaths are way down and SFA and cholesterol intakes are now much higher.
If dietary saturated fat and cholesterol intake are very low and serum nonHDL-C is very low then there will likely be little atherosclerotic plaque even in the presence of HTN. As we have seen in children with no LDL-receptors and very high nonHDL-C levels you can get plenty of atherosclerosis even with very healthy BPs of 100/60. Since the accumulation of cholesterol in the artery wall is the primary pathological event leading to coronary artery disease and atherosclerotic CVD events (mostly CAD) elevated BP with very low nonHDL-C levels prevents atherosclerosis. Oddly enough it appears to me that atherosclerotic plaques in the carotid arteries may actually be somewhat protective against hemorrhagic stroke in people with very high BP, perhaps because the narrowing of carotid arteries lowers BP in the brain - at least that is my speculation. The lower BP in the brain may then reduce the risk of hemorrhagic stroke - as these strokes are largely related to BP rather than atherosclerosis.
If you want to reduce atherosclerosis lower serum nonHDL-C by eating less SFA and cholesterol. If you want to reduce hemorrhagic stroke risk lower BP by eating a lot less salt. If hemorrhagic stroke, heart attacks, and heart failure are not something you want in your future I'd say limit salt, SFA, and cholesterol.
BTW - veins have the same cholesterol as do arteries but they almost never develop atherosclerosis do they? Want to see veins develop atherosclerosis? Have a bypass procedure that removes a healthy plaque-free vein from your leg and use it to bypass and atherosclerotic coronary artery. Not long before that vein develops a lot of cholesterol filled atherosclerotic lesion. What changed the BP or the serum cholesterol level in that vein? What does that tell you? Clearly a diet high in SFA and cholesterol and low in salt results in atherosclerosis. Add salt and increase the BP and yet more of those elevated apoB-containing lipoproteins will get forced into the artery wall and the plaques will grow even more quickly.
If someone has both a nonHDL-C level and a SBP of 100 each their risk of any CVD event will be extremely low. Now ask yourself if you had to have one or the other of these CVD risk factors doubled to 200 which one would you pick? Food For Thought"
"If you look at the ASCVD risk calculator and adjust for cholesterol and hypertension with all other things being equal, you can see you have to have a pretty high blood pressure, uncontrolled on medication for the risk calculator to give the same cardiovascular risk as total cholesterol 240 with HDL 50 in excellent blood pressure on no medications (i.e. the ASCVD calculator biases towards cholesterol being a bigger issue than blood pressure."
JeffN wrote:3) avoid blood thinners including medications and supplements/herbs that are blood thinners,
Mom+Me wrote:JeffN wrote:3) avoid blood thinners including medications and supplements/herbs that are blood thinners,
Jeff, would you include the use of garlic, especially raw? We often eat quite a bit of it, yet it can thin the blood.
JeffN wrote:Mom+Me wrote:JeffN wrote:3) avoid blood thinners including medications and supplements/herbs that are blood thinners,
Jeff, would you include the use of garlic, especially raw? We often eat quite a bit of it, yet it can thin the blood.
Are you eating it for its flavor or a therapeutic reason?
The most powerful are the medication but, yes, ginger is included in the usual lists.
The answer depends on the individual and the form/type of the supplement, but certain herbs/supplements can have an impact, especially if taking several of them. The issue most of the MDs (And even dentists) are most concerned about is the period a few weeks prior to a few weeks after any surgery.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459456/
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Jeff
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