Mark Kaplan: Same LDL-C, Different Coagulation, Different Outcomes, in FH
Mark Kaplan, Managing Partner, Co-Founder of Paradigm Capital International, MD, International Distribution at SaveDaily, Head of International Sales at Axonic Insurance Solutions, Founder and Chairman of HealthTruth, Creator of Neo, shared a post on X:
“David Diamond sent me three papers on Familial Hypercholesterolemia this week.
I read all three. And one table changed how I think about FH entirely.
Across multiple studies, the researchers compared FH patients who developed cardiovascular disease to FH patients who did not.
The LDL-C was not significantly different between the two groups.
Let that land.
Same genetic diagnosis. Same lifelong LDL elevation. One group had events. One group did not. And the number that every doctor uses to justify treatment was the same in both.
What was different: coagulation. Lp(a). Factor VIII. Fibrinogen. The FH patients who died early had highly reactive platelets and a prothrombotic profile. The ones who lived did not.
Diabetes, smoking, stress, and insulin resistance amplified the coagulation response. Those without these risk factors lived long healthy lives with high LDL.
And here is where it connects to everything we have been talking about this week.
Nitric oxide is one of the most potent natural anticoagulants in your body. It inhibits platelet aggregation. It suppresses thrombosis. When your eNOS enzyme uncouples and nitric oxide collapses, you lose that protection. The blood becomes stickier. The clotting risk rises.
The same LDL becomes more dangerous not because there is more of it but because the system that kept it safe is broken.
The coagulation factors Diamond identified as the separating variable in FH may be downstream of nitric oxide depletion. The same mechanism. The same scale. The same fulcrum.
One more finding from the BMJ paper.
Cochrane reviewed 15 dietary RCTs for FH and concluded: no conclusions can be made about the effectiveness of a cholesterol-lowering diet. The dietary advice given to every FH patient exists in what Diamond calls ‘an evidence-free zone.’
Same LDL. Different coagulation. Different metabolic environment. Different outcome. Measure the right things.
Then decide.
- Diamond et al. BMJ Evidence-Based Medicine 2021.
- Ravnskov, Diamond et al. Int J Mol Sci 2
- Ravnskov, Diamond et al. Medical Hypotheses 2018.
The truth heals.”
Stya updated with Hemostasis Today.
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