Yes, LDL is the best we have since they won’t bother to measure oxidative stress nor inflammation in the human body.
But lowering your LDL does not prevent heart disease. There are many many people with normal LDL who have heart attacks.
In fact, it is the norm. And I can’t imagine how many people are being told. They have no heart disease risk just because their LDL is normal. It’s a crime and it needs to be stopped.
A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.
> But lowering your LDL does not prevent heart disease. There are many many people with normal LDL who have heart attacks.
Wearing a seatbelt does not prevent death in a car accident. There are many people who wear seatbelts who still perish in car accidents.
While you can find a vocal minority who claim cholesterol is not related to heart disease, the best evidence we have is that it is. A lot of the doctors pushing cholesterol denialism are into quacks, such as Uffe Ravnskov who pivoted from denying a link between LDL and CVD into preaching Vitamin C to treat COVID when that hit the news.
However, it's not the only actor in determining heart attack risk.
Lowering LDL isn't equivalent to a seatbelt. A seatbelt is a safety device that performs a function in an accident.
LDL is used as a predictor because it is easy to measure not because LDL itself causes heart disease. Lowering LDL doesn't actually do anything on its own, because it is just a proxy metric for the underlying problem.
It's more cranky to shutdown discussions by misrepresenting someone's position as "cholesterol denialism". What does that even mean in this context? Finding better predictors is denialism. Great now we just need a ministry of truth.
>Lowering LDL doesn't actually do anything on its own
Is this some sort of weird philosophical statement? Because, of course, it's completely nonsensical, and completely at odds with all data on this file.
Lowering LDL reduces CVD incident rates, with no other interventions. People with genetically low LDL also have lower CVD incident rates. This is extraordinarily well proven.
So it sure seems -- you know, 100% of medical science -- that lowering LDL does "something".
The human body is a complex machine, however, and CVD is multifactorial, and for CVD to develop the current thinking is that you need inflammation and high cholesterol over decades. Inflammation can be caused by things like high blood pressure and the like. But everyone has inflammation to some degree as a facet of living, and the easiest component of that to treat (not just measure) is LDL.
And yes, there is an industry of cholesterol denialists, among whom there are just loads and loads of chiropractors. These clowns have built armies of poorly informed disciples that run to HN to tell us that cholesterol doesn't matter and lowering LDL doesn't do anything.
> People with genetically low LDL also have lower CVD incident rates. This is extraordinarily well proven….. you need inflammation and high cholesterol over decades.
We know that low LDL does not prevent CVD. Therefore we know that you do not need high cholesterol over decades.
It's like saying a flying bullet can't do anything on its own. It is a meaningless statement.
>As I pointed out in another post over 75% of people who have heart attacks have normal LDL.
The actual study authors were advocating for lower LDL guidelines, particularly among the elderly.
A heart attack is the destination, not the journey. What someone's LDL was at admission for a heart attack says literally nothing about their state for the decades before. In actual studies tracking cholesterol, even over a five year period lowering LDL has a potent beneficial effect.
>You’re saying a lot of nonsensical stuff in your comment like high blood pressure causes inflammation , which tells me you are not serious in this discussion
Hypertension can cause endothelial inflammation, leading to blood vessel damage and promoting the release of inflammatory mediators. This is extremely well documented, and it's why getting hypertension under control medically is considered extremely important in the CVD battle. Inflammation and hypertension often are found hand in hand, and there is uncertainty over the cause and the effect, but strangely controlling hypertension alone dramatically reduces inflammation. Weird, right?
>I have zero inflammation
Sorry, but LOL. Not only is that a singular and very narrow test, inflammation is literally just a facet of living. As is oxidization. There isn't a single human alive with "zero inflammation", nor is there anyone that has magically non-odidizing LDL.
If you don’t understand the difference between acute and chronic inflammation, there is no longer any reason to continue this conversation with you. Yes, I apologize because I didn’t specify the difference, but I thought you would be intelligent enough to know the distinction.
Localized foam cell activation and cytokine signaling does not necessarily raise hsCRP yet allows for continue plaque deposition. This is a very well understood mechanism.
No one knowledgeable here is saying that inflammation isn't worth paying attention to, but people acting like because inflammation is also important that LDL does nothing just aren't living in reality.
Your comment about blood pressure actually reveals more about your knowledge here than the person you're replying to.
FDG-PET is a signal we can use to detect tissue inflammation, and we know that higher blood pressure is highly correlated with increased FDG-PET in arterial walls:
Blood pressure results in shear stress to your arteries. This results in several things that amplify Angiotensin II and NF-kB activity, including expoosing adhesion molecules which then results in foam cell activation and cytokine signaling, etc.
It is quite well established that high blood pressure will contribute to increased inflammation.
That people can still experience a heat attack even with low LDL does not change that fact. We have very large studies showing the efficacy of lowering LDL.
>But lowering your LDL does not prevent heart disease
Literally one of the most proven truths in medical science is that LDL levels has an almost directly relationship with CVD risk over the long term. Someone with low cholesterol can of course still have CVD, but their odds are much better than someone with high cholesterol. And of course the damage from cholesterol is additive, so the earlier you control LDL, the more of a benefit.
>A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.
The damage from high cholesterol happens over decades. Yet the people who actually have heart attacks are often older.
So yes, if gramps spent his life with high cholesterol but now he barely eats and is sedentary, he might have low cholesterol now but that says literally nothing to what you're claiming it does.
Yes, much like wet streets are a high predictor of rain. Or smoke, firefighters and wood are a high predictor of fire. The firefighters are not causing the fire, neither do the wet streets cause rain. This is what people are trying to tell you. If you remove the firefighters only, then you might make it worse. If you do something to cause the firefighters to go away, probably because there isn't a fire anymore, then you did the right thing. The important thing is not to goodhart's law yourself into doing the wrong thing.
This would be a fair analogy if we didn't have studies with a temporal component, but we do. We look at individuals before they get disease then track them over time to see what predicts disease. So we can see, per your analogy, that the fire is there, then the firefighters turn up.
No. They’re saying that damage is cumulative over a lifetime - plaque deposition - so that a point in time snapshot of LDL says little about lifetime exposure. If I live my life with high LDL and only get on statins at 65 I might have low LDL when I have a heart attack but the damage came from the decades of high LDL.
The current guidance from the AHA and NLA is that lower is better for as long as possible.
Lower cholesterol helps but lowering inflammation helps everyone. As I’ve said in another comment over 75% of people who have heart attacks have normal LDL levels.
And lower cholesterol is not without its own risks. You need cholesterol to make hormones and things like CoQ10, which are important for our health. So what’s better? Lowering oxidative stress and inflammation or lowering cholesterol?
LDL levels at admittance do not tell us what their lifetime LDL levels were. But even your own link is arguing for lowering the the number at which we consider LDL levels risky.
PCSK9 inhibitors when coupled with statin therapy have gotten people to ~10 LDL without negative impact in clinical trials. The body is good at producing cholesterol where it needs it - it doesn't pass the blood brain barrier, yet the brain is full of it. It produces it's own, the same as quite a lot of other tissue
For hormones, de novo synthesis of cholesterol is a thing when it comes to steroidgenesis, as well as recycling and re-uptake. PCSK9 inhibitor studies specifically looked at this because of this concern, and found cortisol/aldosterone/testosterone/estrogen/etc. were not impacted by having very lower levels of LDL-C.
The issue with statins and CoQ10 isn't cholesterol - it's the mevalonate pathway. They block a reductase in the pathway and this results in lower serum CoQ10 levels. Data around if this is of any clinical relevance is a mixed bag, but this is easily supplementable if needed, and should not be a reason to not take life saving medication. PCSK9 inhibitors make large dents in LDL but do not impact CoQ10 levels at all because they do not impact the mevalonate pathway.
But lowering your LDL does not prevent heart disease. There are many many people with normal LDL who have heart attacks.
In fact, it is the norm. And I can’t imagine how many people are being told. They have no heart disease risk just because their LDL is normal. It’s a crime and it needs to be stopped.
https://www.uclahealth.org/news/release/most-heart-attack-pa...
A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.