The ultimate goal in lipid management is to normalize ApoB or LDL particle number, as this addresses the primary drivers of atherosclerosis and helps manage remnant lipoproteins.
For proper clinical decisions, especially in patients of concern, utilize particle numbers (ApoB or LDL particle number) instead of solely relying on non-HDL cholesterol, due to significant discordance between these metrics.
Refrain from using the terms “good cholesterol” and “bad cholesterol” when discussing lipids with patients, as these terms are misleading, lack scientific meaning, and can miseducate patients about their actual risk based on blood measurements.
Do not rely on LDL cholesterol, total cholesterol, or HDL cholesterol as sole metrics for understanding cholesterol flux and trafficking, as they provide zero information about the complex movement of cholesterol.
Be cautious when interpreting HDL cholesterol levels; low HDL-C doesn’t clarify if cholesterol pickup is failing or delivery is efficient, and high HDL-C doesn’t clarify if pickup is high or drop-off is deficient.
When reviewing historical epidemiological data that links low HDL cholesterol to risk, recognize that these studies often did not adjust for ApoB or LDL-P, and if they had, low HDL cholesterol would likely cease to be an independent risk factor.
Stop using the term “reverse cholesterol transport” because it is an oversimplification of an immensely complex system, and there are currently no biomarkers to accurately evaluate this process in individual patients.
Aim to keep VLDL cholesterol levels below 15 milligrams per deciliter, especially in insulin-resistant patients, as this marker can indicate the presence of remnant lipoproteins contributing to pathology.
For individuals with very high HDL cholesterol but accelerated atherosclerosis (indicating dysfunctional HDL), the primary strategy is to lower ApoB and aggressively manage all other identifiable cardiovascular risk factors.
Apo C3 is overexpressed in insulin-resistant situations and its presence on lipoproteins significantly increases their plasma residence time and atherogenicity, making it a potential future clinical assay for identifying problematic remnant lipoproteins.
When prescribing or considering nutritional therapies, it is very important to understand the complexities of lipid transportation and particle functionality, as this knowledge should inform dietary recommendations.
When evaluating changes in lipid markers, especially in insulin-resistant patients, always consider the absolute increase in particle numbers, not just the relative percentage increase, as absolute changes often dominate the overall risk picture.
When reviewing older scientific or medical information, especially in rapidly evolving fields like lipidology, be aware that understanding and recommendations can change significantly over time.
When considering new therapeutic approaches, especially those with unknown long-term effects or residual presence in the body, prioritize therapies with established safety profiles and consider if existing or emerging alternatives offer comparable or superior benefits without the same risks.
Be extremely cautious with new pharmaceutical interventions, especially those that significantly alter biological systems, as unforeseen long-term side effects or toxicities can emerge, as seen with past drugs like Vioxx.
Actively seek out mentors or colleagues who are not afraid to directly correct your misunderstandings or challenge your assumptions, as learning from such individuals can significantly deepen your understanding.
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