TLDR: The current advice that LDL is “bad cholesterol”, appears to be outdated, and the actual situation is more complex. In people over 60 high LDL appeared to be protective for mortality.

Conclusions: High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.

Full Paper at https://pubmed.ncbi.nlm.nih.gov/27292972/

Related to, and following up on the LMHR paper from https://hackertalks.com/post/5835924

  • jetOPMAEnglish
    2·
    9 days ago

    A conversation about cholesterol in another community reminded me I needed to review this paper off my backlog.

    https://hackertalks.com/post/6005633/6295546

    When we see the flip flopping of advice I think it tells us the science is inconclusive or the relationship noisy.

    https://pubmed.ncbi.nlm.nih.gov/27292972/ Here is a systematic review from 2016 saying high LDL is protective vs low LDL, which goes against the current lipid hypothesis - I just point this out because it goes to your point that the advice given flip flops!

    This was a good video, but the core question is does LDL CAUSE atherosclerosis or is it associated with atherosclerosis? The video above even says the body will make LDL regardless of diet, so its clearly biologically necessary (that is to say LDL is not a disease). Bad Cholesterol is a poor name for LDL since it is biologically necessary.

    There is literature currently saying decreasing LDL has a very small, but real risk reduction across a large population. But since its such a weak signal, I think LDL is a correlated biomarker and not the cause of atherosclerosis. i.e. If every fire you see has firefighters, you might start to think that firefighters start fires.

    In the literature there are much stronger hazards to cardiovascular outcomes then LDL, such as metabolic dysfunction, diabetes, hypertension, etc. And very importantly differentiating healthy LDL that gets reused, vs damaged (glycated, oxidized) LDL

    LDL is a risk factor, but it should be one datapoint in a panel (obesity, insulin sensitivity, hyper tension, CAC scores!!!, previous CVD events), not just a biomarker people try to treat in isolation.

    If this is of interest, I recommend reading this writeup on LDL, its very balanced and cites its sources with confidence scores (the little numbers) https://www.dietdoctor.com/cholesterol/elevated-ldl-cholesterol

    • jetOPMAEnglish
      1·
      9 days ago

      I do think there is a case for lowering LDL - in patients with advanced atherosclerosis, where the LDL combined with plaque might prevent blood flow. In this limited scenario it is a net positive. Don’t treat the metric (LDL), treat the disease (atherosclerosis). Demand a CAC (Coronary Artery Calcium Scan) before starting on medication that has huge metabolic implications (statins).

      firefighter example

      https://www.youtube.com/watch?v=2bqkDjVyu80

      If your body is already on fire, you don’t want the firemen blocking the roads causing everything to seize up