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Penny: Very interesting and not unexpected data. Is this paper published? If so what is the reference? TD

Actually, the interesting thing about POSCH in the original paper was that serial angiograms showed marked plaque stabilization/regression when LDL was brought very low, despite very low HDL and very high blood pressure. Achieved LDL levels were the lowest on record, as far as I know, ranging between 20-40 mg/dl. Achieving such levels of LDL in clinical practice is not practical or financially feasible. I have suggested a global risk approach using a ratio between LDL and HDL (specifically, the Cholesterol Retention Fraction, or CRF, defined as [LDL-HDL]/LDL), systolic blood pressure (SBP), and cigarette smoking. The tool utilized a graph with CRF on the abscissa and SBP on the ordinant. There is a threshold line with CRF-SBP coordinates of (0.74, 100) and (0.49,140). The graph was presented in the Letters to the Editor section in the Journal of Clinical Lipidology earlier this year. Validation of the graph was presented at the NLA annual symposium in Chicago last May.

It tells me the crude surgery brought down the ldl-c and it compensated the downfall of hdl decrment by surgery.Itreiterates the importence of apoB

Dear Dr Ichintam,
What POSCH reveals is that when LDL is low enough, HDL is immaterial. However, treating to LDL levels achieved by POSCH is not practical.
Sincerely,
W.E. Feeman, Jr,MD

i agree with Dr. Feeman's statement,.. "What POSCH reveals is that when LDL is low enough, HDL is immaterial. However, treating to LDL levels achieved by POSCH is not practical." Global/Multiple risk factor management seems most practical & adaptable to a larger variety of patients. RE: The Oct 2009 J Clin Lipidol "The identification of occult cardiovascular disease through
the use of a novel biomarker: a case report" a good example wher the ApoB was NOT the problem,.. rather inflammation WAS: LpPLA2/MPO,. with a large soft plaque as evidence that aggressive med tx was needed.