
Lean Mass Hyper-Responders: An Exception to the Cholesterol Rule? - Revisited
Physionic
Apr 20, 2025
Mindsip insights from this episode:
Understand plaque progression variability in LMHRs
Plaque progression was extremely fast in the minority of LMHRs who already had calcified plaque, but much slower in the majority who did not.
Identify lean mass hyper-responders on low-carb diets
A lean mass hyper-responder is a lean person on a low-carb diet with LDL cholesterol over 190 mg/dL, low triglycerides, and high HDL.
Recognize arterial plaque progression in lean mass hyper-responders
Contrary to some beliefs, the study showed that lean mass hyper-responders, on average, still experience arterial plaque progression over one year.
Challenge assumptions: High APOB and LDL levels do not drive plaque growth
The study's most controversial finding is that there was no association between high APOB or LDL levels and the rate of plaque growth in this group.
Challenge percentage metrics in plaque increase analysis
Researchers argue you cannot use a percentage to measure plaque increase because the starting amount was so low, making any absolute change seem astronomically high.
Recognize uniqueness of treatment-naive LMHRs in research comparisons
A key defense is that you cannot fairly compare this unmedicated group to other studies where participants are on statins or other plaque-slowing therapies.
Challenge the ironic 'threshold' hypothesis for LDL understanding
Some now propose a new, unproven 'threshold effect' for LDL to explain the data, which ironically contradicts the standard models they usually oppose.
Get a CT angiogram to assess plaque burden if you're a lean mass hyper-responder
Given the uncertainty, if you are a lean mass hyper-responder, you should consider getting a CT angiogram to determine your current plaque burden.
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