Letter from the insurance company 18. March 2011 William Davis (24) Claudia got this letter from her health insurance company:Dear Ms. ------,Based on a recent review of your cholesterol panel of January 12, 2011, we feel that you should strongly consider speaking to your doctor about cholesterol treatment.Reducing cholesterol values to healthy levels has been shown to reduce heart attack risk . . . Okay. So the health insurer wants Claudia to take a cholesterol drug in the hopes that it will reduce their exposure to the costs for her future heart catheterization, angioplasty and stent, or bypass surgery. This is understandable, given the extraordinary costs of such hospital services, typically running from $40,000 for a several hour-long outpatient catheterization procedure, to as much as $200,000 for a several day long stay for coronary bypass surgery.So what's the problem? Here are Claudia's most recent lipid values:LDL cholesterol 196 mg/dlHDL 88 mg/dlTriglycerides 37 mg/dlTotal cholesterol 291 mg/dlBy the criteria followed by her health insurer, both total and LDL cholesterol are much too high. Note, of course, that LDL cholesterol was a calculated value, not measured. Here are Claudia's lipoproteins, drawn simultaneously with her lipids:LDL particle number 898 nmol/LSmall LDL particle number less than 90 nmol/L (Values less than 90 are not reported by Liposcience)LDL particle number is, by far and away, the best measure of LDL particles, an actual count of particles, rather than a guesstimate of LDL particles gauged by measuring cholesterol in the low-density fraction of lipoproteins (i.e., LDL cholesterol). It is also measured and is highly reproducible. To convert LDL particle number in nmol/L to an LDL cholesterol-like value in mg/dl, divide by ten (or just drop the last digit). Claudia's measured LDL is therefore 89 mg/dl--54% lower than the crude calculated LDL suggests. This is because virtually all of Claudia's LDL particles are large, with little or no small. This situation throws off the crude assumptions built into the LDL calculation, making it appear that she has very high LDL cholesterol. Do you think that Big Pharma advertises this phenomenon?