About me

Welcome to Doc’s Opinion.

The blog is written and edited by Axel F. Sigurdsson MD, Ph.D., FACC.

Dr. Sigurdsson is a cardiologist at the Department of Cardiology at The Landspitali University Hospital in Reykjavik Iceland. He also practices cardiology at Hjartamidstodin (The Heart Center) which is a private heart clinic in the Reykjavik area. He is a Fellow of the American College of Cardiology (ACC), The Icelandic Society of Cardiology and the Swedish Society of Cardiology. He is a past president of the Icelandic Cardiac Society.

Dr. Sigurdsson is also a licensed Aviation Medical Examiner. He held the position of Medical Director at Icelandair from September 2004 to August 2019.

Axel F. Sigurdsson
Bringing medical science to the masses is my mission.

Axel F. Sigurdsson MD, PhD

I studied medicine at the University of Iceland between 1978-1984. Upon receiving my medical license, I went to Sweden at the beginning of 1988 for further education and training.

I spent the next eight years at the Sahlgrenska/Östra University Hospital in Gothenburg, Sweden, specializing in internal medicine and cardiology.

In October 1993, I defended my doctoral thesis at the University of Gothenburg, termed “Neurohormonal Activation in Patients with Acute Myocardial Infarction or Chronic Congestive Heart Failure – With Special Reference to Treatment with Angiotensin Converting Enzyme Inhibitors

In 1995-1996 I was a clinical fellow at the Royal Jubilee Hospital in Victoria BC, Canada. The primary purpose of my fellowship was training in interventional cardiology, mainly coronary angiography and percutaneous coronary interventions (PCI’s).

I have published more than 100 scientific abstracts, articles, and book chapters in international journals and textbooks.

Since 1996 I have worked as a clinical cardiologist at the Landspitali University Hospital in Reykjavik Iceland as well as practicing internal medicine and cardiology at Hjartamidstodin (The Heart Center) in Kopavogur, Iceland.

I was born in Vestmannaeyjar, a volcanic island close to the south coast of Iceland on August 21, 1959.

Doc’s Opinion

I started writing Doc’s Opinion in the spring of 2012.

My aim is to write informative high quality articles based on medical science. Evidence based medicine is at the core of my writing.

The main purpose of this website is to provide up to date information on preventive medicine, healthy lifestyle, and nutrition, and to provide reliable and practical information about different medical conditions. Although heart disease plays a central role, I also focus on many other areas of medicine.

My goal has always been to write articles that can be read and appreciated by health professionals as well as the general public. Of course, this is a difficult challenge because the gap between the medical literature and what ordinary people can read and understand may sometimes be difficult to overpass.

Bringing medical science to the masses is my mission.

This blog is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this blog or materials linked from this blog is at the user’s own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

A List of Some of my Published Scientific Papers

Evidence, Not Evangelism, for Dietary Recommendations

Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: A secondary analysis from the CANTOS randomised controlled trial

Effect of interleukin-1β inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: Exploratory results from a randomised, double-blind, placebo-controlled trial

The cardiovascular risk reduction benefits of a low-carbohydrate diet outweigh the potential increase in LDL-cholesterol

Outcome of myocardial revascularisation in patients fifty years old and younger.

Angiotensin Receptor Neprilysin Inhibition Compared With Enalapril on the Risk of Clinical Progression in Surviving Patients With Heart Failure.

Benefits of Statins in Healthy Elderly Subjects What Is the Number Needed to Treat?

Comparison of 30-Day and 5-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients Aged <= 50 Years (the Coronary aRtery diseAse in younG adultS Study)

Prevalence of Abnormal Electrocardiographic Patterns in Icelandic Soccer Players and Relationship with Echocardiographic Findings.

Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality

Screening for risk factors of sudden cardiac death in young athletes

Diagnostic accuracy of 64-slice multidetector CT for detection of in-stent restenosis in an unselected, consecutive patient population

A comparison of all coronary angiographies (CA) performed in 2008 in Iceland and Sweden

Angiographic in-stent restenosis is not related to the inflammatory markers hs-CRP and MPO

Diagnostic accuracy of 64-MSCT for detection of in-stent restenosis

Clinical In-Stent Restenosis is related to stent length and diameter but not to diabetes in an unselected cohort

The effect of physical training in chronic heart failure

Effects of a 5-Lipoxygenase–Activating Protein Inhibitor on Biomarkers Associated With Risk of Myocardial Infarction: A Randomized Trial

Early neurohormonal effects of trandolapril in patients with left ventricular dysfunction and a recent acute myocardial infarction: A double-blind, randomized, placebo-controlled multicentre study

Effects of 3 analgesic regimens on the perception of pain after removal of femoral artery sheaths

Results of percutaneous coronary interventions in Iceland during 1987-1998.

In-hospital heart failure – epidemiology, prognosis and treatment

The role of neurohormonal activation in chronic HF and postmyocardial infarction

Neurohormonal activation and congestive heart failure: today’s experience with ACE inhibitors and rationale for their use

Prevention of Congestive Heart Failure by ACE Inhibition in Patients with Acute Myocardial Infarction

ACE inhibitors in patients with minimal or asymptomatic left ventricular dysfunction

Neurohormonal activation in patients with mild or moderately severe congestive heart failure and effects of ramipril. The Ramipril Trial Study Group

Is neurohumoral activation a major determinant of the response to ACE inhibition in left ventricular dysfunction and heart failure?

Left Ventricular Remodelling, Neurohormonal Activation and Early Treatment with Enalapril (CONSENSUS II) Following Myocardial Infarction

Response of plasma neuropeptide Y and noradrenaline to dynamic exercise and ramipril treatment in patients with congestive heart failure

Effects of ramipril on the neurohormonal response to exercise in patients with mild or moderate congestive heart failure

Short- and long-term neurohormonal activation following myocardial infarction

Neurohormonal effects of early treatment with enalapril after acute myocardial infarction and the impact on left ventricular remodelling

Enalaprilat in acute myocardial infarction: Tolerability and effects on the reninangiotensin system

Anti-arrhythmia agents after myocardial infarction should be used with caution

The Etiology of Bacterial Cellulitis as Determined by Fine-Needle Aspiration

66 thoughts on “About me”

  1. Dear Dr. Sigurdsson: I was directed to your statin link by a correspondent in StoppedOurStatins, a yahoo group I belong to. Thank you for the kind and accurate review of my book, The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs. Indeed, I have no product line, or anything else to sell, except my expertise after more than 35 years as a cardiologist who has also been involved in clinical trials of cholesterol lowering drugs. I am very concerned about the long term risks of statins, particularly on the nervous system.

    I spent one memorable day in Iceland in September 2009 and have great admiration for your country. Having subscribed, I look forward to reading your blog on a regular basis.
    Barbara Roberts, MD, FACC

    • Dear Doctor Roberts. Thanks for your interest in my blog.

      I do think that you have written an important book. I deal with the question of statin therapy almost every day in my practice. These drugs have certainly given us the opportunity to affect the progression of cardiovascular disease and they have improved prognosis for many patients. However, the side-effects during long-term treatment have not been entirely clarified. Millions of people worldwide are taking statin drugs. Therefore it is so important for medical professionals and people in general to have knowledge about these drugs, both the positives and the negatives.

    • Hello Dr. Roberts.
      I am a student at UC Berkeley working on a project that is exploring statin alternatives to reduce high cholesterol. I would love if I could have a couple of minutes of your time to talk about the high cholesterol problem and learn more about it.
      Thank you!


  2. Dear Dr Sigurdsson…

    I am a physician practicing in the Boston area….

    I recently read your comments regarding LDL-C and LDL-P..and their relation to CVD risk factors…You did a wonderful job of elucidating a very complex subject…I too believe that atherosclerosis is an inflammatory disease rather than a lipid disorder as are many of the degenerative disease so prevalent in the USA today.

    I believe there is enough solid peer reviewed evidence to say in the USA that these diseases are caused by our American diet which is too high in Omega-6s and too high in high glycemic index (fast acting) carbohydrates…Omega-6s are substrates for Arachidonic Acid (AA) which increases resting levels of inflammatory eicosanoids. Fast acting carbs raise insulin levels. Insulin increases the rate of AA production from Omega-6s…

    It is unlikely Americans will alter their diets any time soon…Som the next best plan is an antidote to AA. The best one currently available is EPA a component of fish oil..EPA acts to counter AA, by slowing the conversion of Omega-^s into AA and is a competitive inhibitor of AA on the COX and LOX cell membrane sites…EPA being orders of magnitude less inflammatory.. Large population studies have confirmed nations with lower AA/EPA dietary ratios are more heart healthy…The effect of EPA are dose dependent and the dose requirements in the USA are in the 4gm/day level..Much higher than are likely for DS fish oils..

    There is a new drug currently FDA.approved for very high trigs…It is called Vascepa and was developed by an Irish company, Amarin…Their drug is highly purified EPA and it has wonderful clinical trials…If you are unfamiliar with it you should check it out…You might even wish to take it yourself..

    Anthony Weikel MD.

    • Clare. Thanks for providing the reference. I hadn’t seen this paper by Dr. Grimes before. Really looking forward to read it.

    • I read it. Not a particularly interesting nor informative paper. Grimes really has quite a few problems in his argumentation:

      1) His claim that CHD isn’t a multifactorial disease and that its cause is a “mystery”. Err, not exactly. He provides no evidence supporting this, apart from anecdotes (“I recently saw a man …”) and abundant use of a logical fallacy called “false dilemma”. The evidence pointing to a multitude of risk factors behind CHD is – to put it mildly – enormous. To deny this is practically the same as to make a religious statement in scientific discussion.

      2) Another claim by Grimes – that well-known risk factor will (by some magical chance) not be risk factors in the developing world where CVD is already becoming a major problem. This is simply not the case, but Grimes downplays this by a selective reading of his own sources: see citation 68 (the Lancet editorial), which Grimes use to argue for his position by mentioning the apparent inconsistencies in risk factor data from the developing world. However, he fails to realize that the inconsistencies get explained when the confounding factors get accounted for. E.g. obesity rates increase in country X, but at the same time blood pressure & cholesterol don’t –> how come? Well, even in the developing world, medication is becoming more and more available – and the total risk is nearly always a sum of several issues on population level. This really smells the same ol’ BS as the “French paradox”, doesn’t it?

      3) When talking about cholesterol, Grimes makes the same moronic mistakes as cholesterol denialists (is he one, by the way?? Axel, do you know??). E.g. citing Framingham, Grimes argues that high plasma cholesterol levels are detrimental in only young men. Epic fail! The very paper which Grimes cites points out that the connection between increasing overall mortality & falling cholesterol levels in people over 50 is likely to be due to confounding factor of disease which – besides causing untimely death – also cause cholesterol levels to drop. Later on this has been confirmed by both extensive observational evidence and e.g. statin trials where lowering cholesterol has been beneficial in population older than 50 years, as well. See e.g. this


      Not to mention that Grimes’ prediction that CHD risk factors in generations born after the 1950s are somehow be different isn’t shown in observational nor clinical trial data. Nor is the claim that CHD prediction charts “outdated” being backed up evidence. Etc. etc.

      But yes, I do recommend that everyone read the paper. It’ll be a good exercise in critical reading – and a good reminder that just because a paper can get published doesn’t mean it’s worth that much.

    • Mie. I disagree with you about this paper. Of course this is not a scientific study. It is an opinionated review. I found it very intersting. Dr. Grimes challenges many of the current beliefs of the medical community. But if nobody does that, there won’t be any progress.

      Dr. Grimes argues that coronary heart disease is an epidemic, likely caused by an unknown environmental biologic factor, possibly a microorganism. Of course I´m not able to say whether he is right or wrong. However, he makes an interesting case. I enjoyed the historical prespective.

      I don’t know whether Dr. Grimes is a “cholesterol denialist” as you call it, but he dertainly coes not suffer from “cholesterol fixation”. He believes for example that statins may work through other mechansisms than lowering cholesterol.

      • “Mie. I disagree with you about this paper. Of course this is not a scientific study. It is an opinionated review.”

        Indeed. Nor did I claim otherwise. And I did recommend the paper, remember? 🙂

        “Dr. Grimes challenges many of the current beliefs of the medical community. But if nobody does that, there won’t be any progress.”

        Axel, a mere challenge means NOTHING. It’s the content & argumentation & new data that is the key. Grimes’ points are neither new nor convincing.

        “Dr. Grimes arguments that coronary heart disease is an epidemic, likely caused by an unknown environmental biologic factor, possibly a microorganism. Of course I´m not able to say whether he is right or wrong.”

        This bacterial infection -thing as all the rage back in the 90s. You do know why it died away, don’t you? No evidence from trials testing antibiotics in the treatment of CVD and/or regression of atherosclerosis. Of course, bacterial infection can CONTRIBUTE to the progression. However, on the basis of evidence they don’t seem to be cause.

        “I don’t know whether Dr. Grimes is a “cholesterol denialist” as you call it, but he dertainly coes not suffer from “cholesterol fixation”. He believes for example that statins may work through other mechansisms than lowering cholesterol.”

        Err, I don’t think anyone here (apart from Low-fat Richard) suffers from “cholesterol fixation”. I myself have often pointed out that I favor a more holistic approach addressing the multitude of risk factors.

        This is, however, besides the point I made: his arguments in this part (cholesterol & other risk factors) are clearly not valid but flawed. So flawed in fact that the term “opinionated” can indeed be used.

      • Dr. Grimes conclusion could also imply that risk factors may not important anymore, because the epidemic is almost over. That could be a dangerous assumption, not least if it is based on pure speculation. Anyhow, I enjoyed reading the article. Reminded me about how little we know, and how much we don’t know.

      • After reading the paper I wrote to Dr. Grimes. In his reply he said, “I do not believe that coronary heart disease is anything to do with diet…The rise of the epidemic and the fall of the epidemic could not possibly have been due to a dietary factor.”

        I felt inclined to disagree at first. But upon further reflection I decided he may have a valid point. It may be that dietary choices have an impact on vulnerability. In other words, food choices may either furnish protection or accelerate the onset of the disease. Regarding the Kitava Study he noted, “The population of Kitava will not have been exposed to the micro-organism causing CHD and so they do not get the disease. There is no paradox. Smoking does not cause CHD deaths – it brings the time of death forward by about ten years – blog on this to follow shortly. The Greek paradox is that the nation with the highest smoking rate in Europe has had the lowest death rate from CHD.”

      • David, he doesn’t have a valid point. IF he had stated that CHD isn’t just about diet, then yes, the point would’ve been valid.

        But to state that diet has NOTHING whatsoever to do with CHD is simply false given the amount of evidence.

      • “This bacterial infection -thing as all the rage back in the 90s. You do know why it died away, don’t you? No evidence”

        Here are some Pubmed refs for you:

        Microbe/MI: 24001883 9244203 10550273 10738358 11221586 10695364 16441448 9859707 11136684 24820983
        A-biotx/MI: 25752357 25667617 25737169 25704525 25681693 25703120 11927522 9244203
        9952202 12045171 10550273 12045171 9259655 27346378

  3. You are most welcome. It is very well written, easy for non scientific people like myself to follow too. It does not answer questions such as particle size ApoA – ApoB etc., but certainly gives much stimulus for thought. Professor Uffe Ravnskov has (for a long time) theorised that heart disease has a bacterial underpinning, and this paper would seem to perhaps hint at a similar model. Looking forward to your thoughts once you have had time to read it and comment.

  4. Patients have been indoctrinated that the cause of their heart disease/artery disease is from consuming fats… those bad ones which are portrayed as building up inside of arteries, causing blockages and heart attacks/strokes. To say that this has been simply a marketing ploy to scare people into taking drugs is an over simplification. However there is new work being done now to attempt to identify, early, when insulin spikes are doing damage to the body (? vascular system) – not only for diabetes diagnosis. Fats, per se (excluding trans-fats) are not responsible for insulin/sugar spikes – however carbohydrates are….. this is an interesting you tube (I ignore advertising) A very informative You Tube…. the damage elevated sugars/insulin response does to us

    Just sharing what you may not have already seen

  5. hi doc. I am 47, non smoker, no family history but i have subclinical hypothyroidism. Due to high LDL of 211 and cholesterol 253, I run extra tests my self. Here are the results, HDL 59.5, I am homozygous C677T mutation, APO P 115, LpA 9.2, HSCRP 0,7, LP-PLA2 293, homocystein3 18 but lowered to 13 in one month with vitamins, HBA 1 C 5,3, interleukin 1 below 5 and interleukin 6 below 1.5, fasting gloucose 100, MPO < 1:10, BNP 21, CoQ10 1510, small LDL-P 482, LDL size 21.9, HDL-P total 23.3, LDL-P 2146, LP-IR 42, LDL-C 174, Carotides lumen 0.4 at left, 0,5 at the right, RCCA 0,9, LCCA 0,92, LVEF 60 %, wall motion index 1, BMI 24.51, WHR 0.9, BP 105/62 pulse rate 61, TGs 116,. Do I need to go on statins based on my high LP-PLA 2,
    LDL-P, of 2146 high LDL 211,? THANLS A MILLION

  6. Is coconut oil(virgin cold pressed) good to take…a tablespoon a day for heart health or is it too much saturated fat?

  7. Is virgin cold pressed coconut oils safe to take by mouth…one tablespoon a day…for heart health?

    • I’m not aware of any studies suggesting that coconut oils will improve heart health or reduce the risk of heart disease. I also don’t know of any evidence indicating that coconut oils are harmful. So, like so much else in the world of diet and nutrition we really don’t know. Sometimes other factors have to be taken into account, such as body weight, family history, metabolic status and blood lipids. So, my honest answer to your honest question is: “I don’t know” 🙂

  8. Dear Dr. Sigurdsson,

    I am a 50 year old female, 5’5″ 144 pounds. Father had a heart attack at 60, Paternal grandfather died from heart attack at 63, Maternal grandfather from heart attack at 43. No history of heart disease in any females. January of last year my total cholesterol was 278. LDL 103, HDL 146, Triglycerides 54. My Apo B was 77, LDL-P was 1554. Lp(a) Mass 63. My doctor started me on a statin. Labs 9 months later show total cholesterol 252, LDL 56, HDL 171, Triglycerides 57, Apo B 51, LDL-P 793 and Lp(a) Mass 78. Unfortunately my liver enzymes went from normal to ALT/GPT 38, AST/GOT 77. I drink a fair amount of red wine but no other alcohol to speak of. I exercise every day (kickboxing, walking, yoga, tennis) and don’t smoke. I eat very few carbohydrates and almost no grain.

    I am considering stopping my statin because I have a greater fear of dementia and Alzheimer’s disease than heart disease, but I would love to know if you think that would be a good decision.

  9. Dear Dr Sigurdsson, I am female, 61 years old, and quite confused about whether or not to take statins. Two out of three cardiologists have strongly recommended them for me but I do not like the idea of taking them and have not taken any yet. My father had CVD and died at 82 (after back surgery). My mother is 83, quite healthy. She and I both have Mitral valve Prolapse. Mine is mild. Her bloodwork results and mine are very similar and always have been. My blood pressure is always on the low/low normal side, never elevated.

    I have oral lichen planus , osteopenia and am prediabetic (A1C last time – 5.8). I follow a quite strict low-carb, low fat diet (except for grass-fed cow butter, minimal amounts). I have never smoked, do high-intensity strength training a few times a week, am active. BMI 20.5.

    My latest fasting numbers: Total chol: 279 LDL-C 173 HDL-C 96 TRIGL 88 Non-HDL-C 183 Apo B 129 LDL-P 1843 sdLDL-C 32 % sdLDL-C 19 Apo A-I 176 HDL-P 29.4 HDL2-C 47 Apo B:Apo A-I Ratio 0.73 Lp(a) Mass 12 hs-CRP 0.5 Lp-PLA2 208

    It seems that some of these numbers are by the day changing in significance regarding CVD risk. As you certainly can appreciate, it is very difficult for the layperson to wade through them all. I have read that almost every postmenopausal woman over 60 has no business taking statins. I would truly value your opinion on this in my case, as I have no wish to exacerbate my OLP, prediabetes, osteopenia, etc. I am not a combative sort…However, when I bring up concerns re: statin side effects, various studies and debates regarding their true efficacy re: longevity, the cardiologists I have gone to, including the younger female specialists from major hospitals, smile and wave my concerns aside. They are so seemingly programmed as pro-statin (Lipitor in my case) that it frightens me (one prescribed simvastatin for my mother, who was doing fine. She immediately became achy and depressed and came off it against the doctor’s advice.)

    Would simply like to hear your opinion based on my numbers, etc. to help me decide what would be best. Appreciate this very, very much.

  10. Dear Dr Sigurdsson,
    Just wanted to thank you for taking the time to write the blogs. Truly interesting stuff to read.

      • Dr. Sigurdsson,

        I am currently studying to become a dietitian. I love your objective, yet honest posts regarding many controversial/confusing nutrition topics. I have subscribed and look forward to reading you future posts.


      • Thank you Ashley. Appreciate your interest. I’m glad you find the site useful, and thanks for taking the time to mention it.
        Wish you all the best with your studies.

  11. Hi Dr. Sigurdsson, This is a great piece. I would greatly appreciate if you included a mention of my book, which is the source of your arguments. The Big Fat Surprise: Why Butter, Meat, and Cheese Belong in a Healthy Diet (Simon & Schuster) 2014. My book was the first to make this case for rehabilitating saturated fats. I’m so glad to see that these ideas are getting out there, and would really appreciate your citing the source! thank you.

  12. hello i am 48 in good health female dontsmoke or drink unable to ecercise due to back pain and unable to tolerate statins. my recent chol 273,tri 212,hdl66,ldl 165.risk ldl/hdl is 2.4. what is my option. thanks

  13. Dr. Sigurdsson,

    I have been informally studying nutrition and fitness for the past five years or so and only today stumbled upon your blog while researching ways to lower LDL-P. You have a way of making difficult concepts easy to understand, and I look forward to reading more of your posts.

    I am not a physician, but my wife is Swedish, and I studied law at the University of Victoria during your tenure at Royal Jubilee, so there are a couple of oblique connections between us 🙂

    Wishing you a healthy and prosperous 2015.

    With warm regards,


    • Hi Richard

      Thanks for the comment and your interest in my blog.

      Nice to hear about our “oblique connections”. Sometimes I get the sensation that the world is smaller than we think.
      By the way, may son will finish his Master’s degree in law from the University of Iceland next spring.

      Hope you continue to visit Doc’s Opinion.

      Wish you all the best for 2015

  14. Hello,

    I have really enjoyed reading your blogs. I have been getting an NMR profile for the past 3 years I am so confused by the results and what effects the numbers. I had read that increasing cardiovascular and weight training exercise will increase HDL but NOTHING seems to raise my HDL. I tried prescription Omega 3’s also. My HDL at it’s highest was 31 at age 38 and at it’s lowest at age 28 at (13).. YES!!! 13!!!!! Here is my latest NMR profile results. I currently weigh 150 lbs and I’m 5’9 and female. This is the most I’ve ever weighed and I normally weight 125-135. I do weight training and cardio 5 times per week and burn 500-680 calories in each 45 minute workout (it’s intense!). I have never smoked and drink probably twice per year. My weakness is sweet tea, but other than that I eat a balanced diet. I do not drink coffee or soda.


    LDL Particle Number 2368

    LDL C 102

    HDL C 21

    Triglycerides 111

    Cholesterol 145

    LP-IR score 54

    My blood pressure is 110/62 and my resting heart rate is 60 BPM

    This is what I know of my family history ( I didn’t grow up with my parents)

    Mom – died at 53 from massive heart attack ( she lead a very unhealthy lifestyle, addicted to prescription meds, ate only fast food, drank nothing but soda, no exercise and very overweight, very high untreated BP

    Dad – had stint put in at 53 but heavy smoker and drinker and very overweight.

    maternal grandmother – still living with no heart issues

    maternal great grandmother – very overweight and lived to be 85 … had a stroke at 75

    maternal great great grandmother lived to be 108 and died in her sleep … no health issues … rode on the back of a Harley in parade at 107!!! Not overweight, but heavily used tobacco…not smoking but chewing tobacco (gross I know) 🙂

    So, what do you recommend. I went in for a cardiac scoring today but couldn’t do the test due to my heart rate increasing to 110 from 71 everytime I was put in machine.

    HELP!!! Am I doomed?



  15. HI Doc,

    I love your website! I was hoping I could get your opinion on my numbers. I finally got my family Doc to give me script for a fractional lipid panel, as well as a CBC. I am not sure that he really comprehend all of this, as he didn’t know I could even get a fractionated lipid panel. Some background:

    I am a 52 year old male 6’5″, lost weight last year from 246 to 227, Father is 86 and has some of the same type number as me- low HDL, elevated LDL,. Mother is 82 and has hyperlipidemia and takes a fibrate based prescription. I recently cut WAY back on alcohol, to none in past 4 weeks. My body cannot tolerate statins- tried 3 different ones. Currently take daily 4 g. Fish Oil, 1400 mg Red Yeast Rice, 100 mg, Co Q10, 81mg aspirin and Daily vitamin supplement. I also had calcium score done last year on a lark that came back 354.28 on Agatston scale, with 3 calcified spots in my LAD…which scared me. My BP is around 118/78 on average and my cardiac treadmill stress test was uneventful except a couple of blips of PVCs. Here are my numbers:

    Non HDL Cholesterol- 128
    LDL Cholesterol- 97
    HDL Cholesterol- 32 (was 43 last summer when I was drinking more alcohol)
    Apolipoprotein: 89

    LDL Particle: 1333
    LDL Small: 338
    LDL medium: 291
    HDL Large: 3883
    LDL Peak size: 212.6L
    Lipoptotein(a)= 21
    High Sensitivity CRP-= .13

    Testosterone =311
    Fasting glucose 99 (was 101 previously)

    All other numbers on Metabolic/CBC are well within the guidelines

    In general I feel great, I quit eating red meat and saturated animal fats a year ago, and eat olive oil, nuts, whole grains, shrimp, fish, chicken breast, fruits and vegetables…however, my numbers are not where they need to be. I am sort of just throwing my hands up in despair figuring the stress of worrying about my “mild atherosclerosis” will kill me faster then the disease itself..

    I am in a quandary about how to proceed with my dietary intake at this point.

    It just seems to me that the key here is the low CRP level, since atherosclerosis feeds itself and builds plaque from stress and inflammation, correct?

    Thanks in advance, Doc!


  16. Several months ago I had some routine blood work done. At the time my total cholesterol was a whooping 314 even though I have been a vegetarian for over 35 years, exercised, and fasted two days a week. My triglycerides were very good and both the LDL and HDL needed improvement although not esp.bad. My doctor said he was not willing to prescribe a statin for me yet and with his okay I started to take red yeast rice. A few days ago I had blood work done again (at a different facility) and now my total cholesterol is 211…an unbelievable decline in over 100 points. Also the LDL and HDL are now at ideal stages but my triglycerides have gone up. Is it possible that the first facility made a mistake in my cholesterol level? Has anyone else experienced this great a positive decline after using red yeast rice for such a brief time? Thank you.

  17. Hello. I agree with the doctor’s opinion that LDL-P might be a greater indicator for CVD. However, the question really is about what role cholesterol plays in the body and cholesterol is a supportive one. The higher number of LDL is just a symptom of your body repairing damage caused by other factors. Sending multiple ambulances to a bad accident scene doesn’t make the ambulances bad ambulances. The problem isn’t the ambulances. The problem, theoretically was the drunk driver. LDL, whether small particles or not treats systemic inflammatory conditions in the endothelium of the arteries The contents of the LDL that really cause the damage is not the cholesterol but the triglycerides that are contained within the protein package. Cholesterol is an inert substance. It has never killed anyone.

  18. I received a call from my doctor office my LDL was a 5 and my HDL was 79. asked me to come back in something is wrong they are gone to redo the test. My mother had a heart attack at 28 years old and has Mitro Valve prolapse since. Someone please let me know what the low LDL level means. i’m googling things and it’s making me scared. I just turned 40 years old and have a severe anxiety disorder so the constant pain in my heart i just think it’s my anxiety
    thanks colleen

  19. Dear Dr. Sigurdsson

    Do you know about institutions/courses in the US or Europe, directed to physicians/dietitians who want to formally specialize in low-carb diets as treatment to diabetes ?

    Low-carb is still not recognized officially as a sound treatment in Brazil, so I’m searching for a foreign institution which can provide training – brazilians in general trust a lot on anything that comes from US/Europe…

    Best regards!

  20. Dear Dr. Sigurdsson

    I really appreciate your blog. This might be a weird question but I’am a young nurse from Scandinavia who for is highly interested in critical errorfinding in scientific papers especially in the field of medicin and nursing. If you were me what “path” or education choice would you go for.

    I really hope you can help me with this different kind of question.

    Yours sincerely Sean Jobe.

  21. @docsopinion:disqus – My name is Vet and I work for Sovrn Holdings- The third largest ad exhange in the world. Id love to talk to you about your monetization strategy for this site. please email me at vsmelko@sovrn.com

  22. I live in the UK where doctors haven’t heard of the Try/HDL ratio.

    So I have an important query about mention of a conversion factor mentioned for those in Canada & Europe. https://www.drsinatra.com/the-most-important-cholesterol-ratio-to-watch/
    Whether both numbers are in m.mol/L (as in Europe), or, in mg/dL (as in US) it is a RATIO!

    A ratio of two (mass-per-unit-volume) density-units is surely the same (across measurement systems) as long as the two are consistent with each other within their own system???

    Please can someone clarify, I speak to the doc. tomorrow.

    • The molecular weight for TG and HDL-C is not the same. Therefore, the conversion factor for these two is not the same. Hence, the reference ratio for the TG/HDL-C ratio changes when you convert.

      This is what you should use in the UK

      TG/HDL-C ratio less than 0.87 is ideal

      TG/HDL-C ratio above 1.74 is too high

      TG/HDL-C ratio above 2.62 is much too high

      • Thank you for those parameters but can I just divide the two mmol/L measures directly
        1.6 (TG) over 1.36 (HDL) to get ratio 1.17 ? (fairly good?)

        I ask because, due to TC to HDL ratio of 4.6, my doc wants me to take a statin & I’m resisting a bit.

  23. Reading your assertions about Dr. Perlmutter, I’m wondering if you may have missed a crucial detail in his book. The book talks about how grains themselves have changed. In is own acknowledgement of the Mediterranean diet’s inclusion of grains, he talks about how not only wheat has changed but how the processing of it has changed. It has a ton more gluten in it than it used to, and my own research indicates that it’s processed more quickly and shipped when green.

    • You may have a point here and this is certainly something we should take into consideration when talking about the health effecst of grains. However, although I’m generally in favor of carbohydrate restriction and eating more healthy fats, I still miss the scientific evidence for most of Perlmutter’s claims. Don’t misunderstand me, I’m absolutely not promoting grains, at least not for those who are insulin resistant. Is there any study that you know of that has compared the health effects of grains as the used to be and the “modern” typre of grains?

      • Curious how they would get a hold of “paleo” grains to do the study. However, the studies that Pelmutter reference go back to the 60s and before. It’s not like they were published in Yoga Journal. They were published in the Journal of Neurology and other notable publications. Just hasn’t trickled down to the glyphosate-loving citizens yet. Whatever the issue, it’s without a doubt that all attention must be focused on inflammation.

  24. Pardon my post as I am quite new to this and maybe off subject bit. Could you help me understand the Coronary Calcium Scan, the test that ranges from 0 to 401 but can get scores upward to 1000. Is there a way you can help me understand how score interpretation relates back to actual CAD disease as this is an invasive test and not always a direct correlation to occluded artery percentage.

    My wife is a pillar of health, eats right, no fat, vegetarian and never smoked or drank etc. She has been on Crestor for years which appears to maintain appropriate CDL levels. The only negative is her family history notably her father who had 4 heart bypasses. She recently took the Calcium scan test and scored a 467. All arteries scores zero except the left circumvent which was 17 and her LAD which was a 450!
    If what the interpretation says is accurate, she has extensive plaque. Are there false positives from this scan if she does not have this extensive amount of plaque. However, selfishly, I would definitely appreciate any thoughts you might have. She always says she is fine but I have always been concerned about her exertion. Which she will deny. Any thoughts would be greatly appreciated.

    • I’m a chemist doing some “private studies” on nutrition and metabolism. Also having a high LP(a) myself. Lowered my total Chol. significantly with diet change (low Carb and Keto) and moderate exercise. Haven’t done a CAC score CT yet.
      Maybe your wife could look into lowering Carbs and increasing healthy fats in her diet? Do some research on LCHF and also Keto.
      And also Vitamins and Minerals: D3, K2, Magnesium at least – please do some research.

  25. Hi Docs Opinion Team,

    I’m Kevin Raneri from ArticleHub. We are running Health campaign for our client and I was wondering if you accept paid post opportunities. If yes, please let me know your rate per post and how long it will take you to complete an order.

    Also, to receive other blogging opportunities from our clients that are using our BlogDash’s system, I cordially invite you to create a blogger account here https://www.blogdash.com/bloggers.

    If you have any question, please don’t hesitate to contact me.

    Thank you and awaiting your reply.

    Kevin Raneri
    Campaign Manager
    Email: kevin@articlehub.us
    Website: https://www.articlehub.us

  26. Hello Dr. Sigurdsson

    I am a student at UC Berkeley working on a project that is exploring statin alternatives to reduce high cholesterol. I would love if I could have a couple of minutes of your time to talk about the high cholesterol problem and learn more about it. I can also send you an email with questions if that works better

    Thank you!


  27. Dear Dr. Sigurdsson: I am a 60 year old female (5’7′ , 118 lb.) recently diagnosed with PVD and AFIB. I have had 5 angioplasties (3 on one leg and 2 on the other) in the last 6 mo. I do not have diabetes, do not smoke have normal blood pressure and LDL (although now down to 63 with statins). I eat a healthy (Mediterranean-style) diet and, until claudication, exercised regularly (still do, but leg pain prevents me from getting a real work out). I take 81 mg asa, 75 mg Clopidogrel, 25 mg Metoprolol, 40 mg Atorvastatin, Gabapentin 600 mg. I recently found out my Lp(a) is 111 mg/dl and my hs-CRP is 6.6. What would you recommend? Please email me at marilynsgreenberg@gmail.com. Thank you in advance for your help!

  28. Doc,
    I find your blog very useful as I teach health and Human Physiology to future clinicians to always double check with the voice of experience and someone who’s actively seeing patients or has a track record of treating patients and observing the real world of results and cause and effect. I would love if you could post the references for some of the things that you say about ApoB/A ratio and exercise and lifestyle and other things on cholesterol and other themes.

  29. In the paragraph where you quote the Lore of Nutrition
    in your latest post, you may have written LCHF when
    you meant to write LFHC. Dr. Noakes thinks LFHC is
    the worst nutritional info taught in medical schools.

  30. “Disqus” is no longer supported by my mature computer and its limited OS. This makes it likely that many of your more mature followers will be unable to comment. I was prepared to ask about the contentions surrounding treatment of depression on today’s blog page, but was unable.
    Perhaps this will suffice?

  31. Hello,

    My name is India, from Caring.com. I came across your site while searching for senior living sites and communities. We would like to reach the best person on your team who manages the site or the site’s content to see if you could link to this article of ours.

    The article was recently published on Caring.com, which has 3 million visitors per month and is the leading online destination for family caregivers and older adults seeking senior care information and support:https://www.caring.com/articles/heart-health-caregivers

    We’d love to have you include this article on your blog, for instance, via a link like this: Heart Disease Kills, and Women, Especially Caregivers, Are the Target

    Thanks for considering!

    India, Caring.com

  32. Hi there,

    Elliot here, I am working on a blog page for our company Speak-IT Solutions, based out of Worcester UK. We offer the very latest in speech-to-text solutions for industries across the board, many of whom being healthcare professionals. We work closely with organisations like the NHS to provide secure and intuitive workflow solutions like Dragon Medical (currently driving the SNOMED CT Transition).

    We are looking to drive relevant traffic to our blog at https://speakit.blog, as a reliable and informative resource for our clients. A lot of our material is currently aimed at the impact of speech recognition technology in the healthcare sector, we would greatly appreciate it if you could get back in touch regarding pointing your readers in our direction for some quality and informative information on various mobile dictation solutions and how they are being implemented to revolutionise healthcare documentation and receive some of the strain on various organisations.

    Thank you for your consideration

    Kind regards,

    Elliot Rouse

    Marketing Executive, Speak-IT Solutions

  33. Doctor
    We often find ourselves seeking alternate medical opinions in cases of medical conditions involving surgeries or those which engage a painstakingly difficult procedure. However, the kin to the patient often ends up trapped in the loop of not so reliable opinions.

  34. Hello Axel,
    I follow your posts with interest…and always with thanks for your efforts. We exchanged a few messages over the past few years as I continue to work with my doctor to look after my heart health. Recently my doctor organized for me to take a Holter 24Hr ECG Report, not triggered by any symptoms — I am in quite good shape; solid exercise (e.g. swim 1km + set of resistance exercises) every day; ‘normal’ (180cm tall, 82kg) weight; very active sex life; normal blood pressure; clear blood tests — but rather he was just being thorough for my age…I turn 70 next month. The Holter Report is now prompting a visit to a specialist here, but before I do that I would be very grateful for your thoughts about the Report’s findings…

    “Rare ventricular ectopics 1 only.
    A few single atrial ectopics 248 only plus 1 Paraxysmal Atrial Tachycardia run to peak rate of 110pm for up to 6 beats with variable AV block.
    No Pauses.
    Otherwise Sinus Rhythm 41 to 78pm with an average rate of 54pm.
    No cardiac symptoms reported.”

    From my readings about the issues for me, it appears to me that my greatest risk ‘flag’ is my age…and perhaps the fact that I drink alcohol regularly. Otherwise, however, I can see no compelling case — and I admit I am VERY reluctant — to take any medications (as suggested by my doctor as possible) to slow my heart.

    I will be very grateful for your comments about those ECG results. If a patient presented to you with that report, and my overall health, would you recommend medication(s)?

    Thanks again for all your efforts to promote medical information and understanding to the pubic,

    Don Church
    Blue Mountains, AUSTRALIA

    • Hi Don
      Thanks for getting in touch.
      As you know I’m always reluctant to advise on individual cases because it would simply be irresponsible of me to do so.
      At my clinic we usually don’t treat arrhythmia of the type you described if it’s asymptomatic. However, if symptoms are present, beta blockers are usually our first choice when it comes to drug treatment.

      • Thank you Axel, for both your reply and your ongoing contributions to bringing accurate medical information to the public.

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