Yet more studies indicating LDL (or TC) are not good indicators of heart disease risk

(Bob M) #1

Found this on Dr. Malcolm Kendrick’s website:

https://www.amjmed.com/article/S0002-9343(18)30404-2/fulltext

It’s entitled " A Reappraisal of the Lipid Hypothesis". Here’s one section (bold added), entitled “Clinical trial results”:

The randomized controlled trial (RCT) is the gold standard for validating or rejecting a medical hypothesis. Initial proof of the lipid hypothesis came from some of the earliest RCTs of cholesterol reduction, such as the Coronary Primary Prevention Trial of cholestyramine and the first statin trials (Scandinavian Simvastatin Survival Study [4S], West of Scotland Coronary Prevention Study [WOSCOPS], and Cholesterol and Recurrent Events [CARE]). More widespread trials over the next 20 years produced mixed results, however.[2](javascript:void(0):wink: Regrettably, some clinical trials prior to 2004 have been tainted by scandals that led to new clinical trial regulations intended to safeguard patients and lend credibility to subsequent trials.[3](javascript:void(0);), [4](javascript:void(0):wink: The table summarizes 29 major RCTs of cholesterol reduction reported after the publication of these regulations (Table). Notably, only 2 of these 29 studies reported a mortality benefit, while nearly two-thirds reported no cardiovascular benefit at all. These unfavorable outcomes and inconsistent results suggest that the lipid hypothesis has failed the test of time. Alternatively, some have suggested that this lack of benefit could be due to inadequate intensity or duration of treatment, insufficiently powered studies, targeting LDL-C instead of apolipoprotein B, or perhaps these trials are attempting to lower LDL-C too late in the course of the disease.

The table associated with that section is devastating to the lipid hypothesis.

Another study, entitled " LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature":

https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391

This is a “perspective” study, meaning it’s more opinion than anything else, but it is based on analyses of other studies.

Two parts in the abstract section:

Areas covered : The authors of three large reviews recently published by statin advocates have attempted to validate the current dogma. This article delineates the serious errors in these three reviews as well as other obvious falsifications of the cholesterol hypothesis.

Expert commentary : Our search for falsifications of the cholesterol hypothesis confirms that it is unable to satisfy any of the Bradford Hill criteria for causality and that the conclusions of the authors of the three reviews are based on misleading statistics, exclusion of unsuccessful trials and by ignoring numerous contradictory observations.

As background, there’s a theory that something cannot be proven to be true, but can be falsified (proven to not be true).

(Bob M) #2

Oops, I guess I never finished that thought. So, they attempt to falsify the cholesterol hypothesis (that “cholesterol” as per total “cholesterol” or LDL “cholesterol”) cause heart disease or increase heart disease risk. The Bradford Hill criteria are criteria used for epidemiological studies, and are used to judge whether epi evidence might show causation. Here’s Wikipedia:

(You've tried everything else; why not try bacon?) #3

Although epidemiological studies can rarely prove causation (the connection between smoking and lung cancer is an exception, because of the magnitude of the effect and because of the dose-response relationship), they can be used to disprove causation. For example the fact that well over half of the patients who arrive in emergency rooms with their first heart attack have normal or low LDL levels strongly indicates that LDL has no role in the etiology of cardiovascular disease. So does the fact that fully half of people with familial hypercholesterolemia (a genetic predisposition to high cholesterol levels) live to a ripe old age without ever developing cardiovascular disease, despite their high cholesterol levels. And so do the large studies funded by the U.S. National Institutes of Health (the Women’s Health Initiative, the Minnesota Coronary Study, MR-FIT, and Framingham all come to mind) that actually seem to show a negative correlation between cholesterol and heart disease–especially since they were intended to provide evidence for the diet-heart hypothesis, not against it.

(Bob M) #4

I agree with you, Paul. Although I would say that all lipoproteins have some role to play in heart disease, just not the roles we’ve been taught. For instance, for me, I use HDL as a marker of (whole-body) insulin resistance, though HDL also has anti-inflammatory effects, too.

What was new to me about these studies was the demarcation at 2004. I did not know that people considered statin studies done before 2004 to be less credible than studies done after (and I’ve read many books on the cholesterol hypothesis).

The whole problem with this area, too, is that it’s “slippery”. If TC is shown to be a bad predictor, then it must be LDL. If that’s shown to be a bad predictor, then it must be the HDL/trigs ratio (or there are so many other ratios we could use). Or maybe it’s Lp(a) or the size of your LDL/HDL or “oxidized” LDL/cholesterol or LDL particle count or…

It’s never ending. It has a life of its own, because people simply believe it to be true. Dr. Attia, for instance, refuses to believe anything else could be true.

Again, it’s not scientific. In science, if something fails once, it fails. A new theory is needed. Here (and with nutrition), it can fail over and over and over, yet they slightly tweak the theory each time. It’s impossible to disprove something that keeps changing. The lipid theory isn’t wrong – it just needs to be “adjusted”.

It should simply be scrapped. But while drug manufacturers keep making tons of money and keep influencing the American Heart Association (OWNED by drug manufacturers and producers of crap foods) and American Medical Association, we don’t stand a chance to get other scientific viewpoints out there.

The whole system of training medical professionals also has to change. It should NOT be eminence-based. It should be science based. Eminence-based medicine brought us stents, which show no benefit for most patients:

https://www.bmj.com/content/359/bmj.j5076

Or:

Just because we can do something does not mean we should do something. But this is what happens when medicine is eminence-based and not science-based.

(You've tried everything else; why not try bacon?) #5

Dr. Malcolm Kendrick, a Scottish cardiologist, has a whole series on the causes of heart disease. He is decidedly not a believer in the diet-heart or lipid hypothesis.