New Research Confirms We Got Cholesterol All Wrong

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ERO

Member
A comprehensive new study on cholesterol, based on results from more than a million patients, could help upend decades of government advice about diet, nutrition, health, prevention, and medication.

"No evidence exists to prove that having high levels of bad cholesterol causes heart disease, leading physicians have claimed"
 
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Guided_by_Voices

Well-Known Member
I recommend that those interested in this general topic read Dr. Malcolm Kendrick's series on What Causes Heart Disease (now on Part 56). Not only does it have a lot of great information, it provides a great lesson in how to look at a complicated problem.

It's encouraging to see the paper above getting widespread visibility since the data has been around for a long time. I would add that even if LDL was a problem, that doesn't mean lowering it will be helpful, and the studies that have looked at all-cause mortality for statins have consistently found very little (IMO zero) benefit.
 

dnfuss

Active Member
I would add that even if LDL was a problem, that doesn't mean lowering it will be helpful, and the studies that have looked at all-cause mortality for statins have consistently found very little (IMO zero) benefit.

Agreed. No statistically significant benefit from taking statins except in middle-aged males with existing cardiovascular disease (secondary prevention), and even there a very weak association (very high NNT). No benefit whatsoever in women or the old, even if they've already had a heart attack, and no benefit for anyone for primary prevention. What little benefit they may actually provide is clearly not related to any lowering of lipid labs.

What does he say about normal LDL cholesterol but very high small LDL particles?

I believe Dr. Kendrick's view (which I share) would be that all of the various lipid labs are basically irrelevant, that they have no value in terms of either prediction or prevention of cardiovascular disease (e.g., the average LDL of heart attack victims is no higher than that of those who don't have heart attacks), and that this endless switching of focus on what is the cholesterol marker to watch (from total cholesterol, to LDL, to particle size, to particle number) is simply an attempt to make a square peg fit into a round hole. There may be an association between any of these lab values and cardiovascular disease (although it is often later proven to be a very weak association, if any), but it is a case of firemen at the fire. Lipoproteins are found in aortic plaques because they're involved in the body's attempt to repair the damaged endothelium. The lipoproteins aren't causing the damage. Therefore lowering their number isn't going to prevent/cure it.
 

jdthoosier

Active Member
This so-called "research" confirms nothing. It's not even research, it's just a review by a group of known cholesterol skeptics, basically rehashing the same old dogma they have been pushing for a while, and continue to regurgitate time after time. I don't know the answers here, but I would suggest you'd google criticism of this group, for example:

Statin Denialism - CSI

And then there is the International Network of Cholesterol Skeptics (THINCS), a group that disputes the role of cholesterol in cardiovascular disease. They are led by Uffe Ravnskov, author of The Cholesterol Myths, and Malcolm Kendrick, author of The Great Cholesterol Con. They cherry-pick the scientific literature to find studies that support their theses, ignore the flaws in those studies, and ignore the vast body of literature that contradicts them.

I'm not arguing for one side or the other, but when one side comes out with extraordinary claims, they are obligated to provide strong evidence, and the cholesterol skeptics don't do that.
 

dnfuss

Active Member
This so-called "research" confirms nothing. It's not even research, it's just a review by a group of known cholesterol skeptics, basically rehashing the same old dogma they have been pushing for a while, and continue to regurgitate time after time. I don't know the answers here, but I would suggest you'd google criticism of this group, for example:

Statin Denialism - CSI

And then there is the International Network of Cholesterol Skeptics (THINCS), a group that disputes the role of cholesterol in cardiovascular disease. They are led by Uffe Ravnskov, author of The Cholesterol Myths, and Malcolm Kendrick, author of The Great Cholesterol Con. They cherry-pick the scientific literature to find studies that support their theses, ignore the flaws in those studies, and ignore the vast body of literature that contradicts them.

I'm not arguing for one side or the other, but when one side comes out with extraordinary claims, they are obligated to provide strong evidence, and the cholesterol skeptics don't do that.
You have it backwards. It is not incumbent on those who question a drug's efficacy to conduct studies showing why it is not effective. On the contrary, those who propose a drug therapy have the obligation to defend it by providing sound studies demonstrating statistically significant benefit (because all drugs have side effects). Those who promote statins have never satisfactorily done that. And they are the ones who cherry-pick the studies to support the results they seek. If you actually read the studies they offer in support of statin therapy and drill down into the data (as opposed to accepting at face value the abstracts where the authors of the study say what has been proved), you would see that what Guided_by_Voices and I have said in our previous posts is correct: reliable double-blind placebo-controlled primary prevention studies (i.e., using subjects who have not had a heart attack but simply have elevated lipid levels) of significant size have not been able to reliably demonstrate a statistically significant reduction in all-cause mortality from the use of statins. Statins unquestionably lower total cholesterol and LDL. Since that lowering does not produce a statistically significant reduction in all-cause mortality in primary prevention, it must follow that such elevated serum lipoprotein levels, in and of themselves, do not increase mortality risk. They may be a marker of disease (and I'm not even so certain of that), but not a cause. This is another way of saying correlation does not prove causation (although lack of correlation does prove lack of causation).
 

blackebob

Member
You have it backwards. It is not incumbent on those who question a drug's efficacy to conduct studies showing why it is not effective. On the contrary, those who propose a drug therapy have the obligation to defend it by providing sound studies demonstrating statistically significant benefit (because all drugs have side effects). Those who promote statins have never satisfactorily done that. And they are the ones who cherry-pick the studies to support the results they seek. If you actually read the studies they offer in support of statin therapy and drill down into the data (as opposed to accepting at face value the abstracts where the authors of the study say what has been proved), you would see that what Guided_by_Voices and I have said in our previous posts is correct: reliable double-blind placebo-controlled primary prevention studies (i.e., using subjects who have not had a heart attack but simply have elevated lipid levels) of significant size have not been able to reliably demonstrate a statistically significant reduction in all-cause mortality from the use of statins. Statins unquestionably lower total cholesterol and LDL. Since that lowering does not produce a statistically significant reduction in all-cause mortality in primary prevention, it must follow that such elevated serum lipoprotein levels, in and of themselves, do not increase mortality risk. They may be a marker of disease (and I'm not even so certain of that), but not a cause. This is another way of saying correlation does not prove causation (although lack of correlation does prove lack of causation).

I could be wrong, but I think it was the food pyramid that was shoved down our throats after cherry picking data that was not properly proven. If that was it, there was plenty of evidence as to how it was all twisted to arrive at the conclusion desired.

My forefathers lived very long times on "Terrible Diets", my father is 84 and has refused a statin for the last 20 years. I said no also.
 

dnfuss

Active Member
I could be wrong, but I think it was the food pyramid that was shoved down our throats after cherry picking data that was not properly proven. If that was it, there was plenty of evidence as to how it was all twisted to arrive at the conclusion desired.

My forefathers lived very long times on "Terrible Diets", my father is 84 and has refused a statin for the last 20 years. I said no also.
Yes, the food pyramid, with a base of "at least 11 servings of healthywholegrains" is one manifestation of the "diet-heart hypothesis," which traces back to Ancel Keys and his "Seven Countries" study. His hypothesis was that higher levels of dietary fat raise cholesterol in the blood and leads to higher heart disease rates. It's called the Seven Countries study because it examined statistics relating to fat consumption and heart disease rates in seven countries (Greece, Italy, Spain, South Africa, Japan, and Finland). The results "proved" his hypothesis. The problem is that more comprehensive data from a wider set of countries does not support this theory (there are countries such as France, Holland and Norway where people eat a lot of fat but have little heart disease and countries such as Chile and Russia where fat consumption is low but the rate of heart disease is high). Keys later insisted that these were the only available data and he was not cherry-picking. But whether that's true or not, the fact is that available data does not support this relationship between fat consumption and heart disease. The recommendations based on that theory, i.e., a low-fat (read "high carb") diet to prevent heart disease, are therefore inherently unsubstantiated.
 

blackebob

Member
Yes, the food pyramid, with a base of "at least 11 servings of healthywholegrains" is one manifestation of the "diet-heart hypothesis," which traces back to Ancel Keys and his "Seven Countries" study. His hypothesis was that higher levels of dietary fat raise cholesterol in the blood and leads to higher heart disease rates. It's called the Seven Countries study because it examined statistics relating to fat consumption and heart disease rates in seven countries (Greece, Italy, Spain, South Africa, Japan, and Finland). The results "proved" his hypothesis. The problem is that more comprehensive data from a wider set of countries does not support this theory (there are countries such as France, Holland and Norway where people eat a lot of fat but have little heart disease and countries such as Chile and Russia where fat consumption is low but the rate of heart disease is high). Keys later insisted that these were the only available data and he was not cherry-picking. But whether that's true or not, the fact is that available data does not support this relationship between fat consumption and heart disease. The recommendations based on that theory, i.e., a low-fat (read "high carb") diet to prevent heart disease, are therefore inherently unsubstantiated.

Yes, I love it when someone who can type bettor than me is able to print what I was trying to say.

Thank you for reading my mind DNFUSS.
Kudos my friend.
 

Leesto

Active Member
Following the ADA diet will guarantee that you remain diabetic or get worse and the AHA diet will guarantee that you are not cured of heart disease. Clearly the foundations on which those diets are built is faulty.
 

Guided_by_Voices

Well-Known Member
@jdthoosier,

Where in the "vast body of literature" is there even one study that shows that statins extend life (i.e. reduce all-cause mortality)? The most recent one from several years ago said that life-span increase over 5 years was anywhere from -5 to +17 days. That to me is a rounding error and IMO the margin of error is far larger than that, which says "no benefit". Other studies have shown the same. That alone should show that even if LDL is a problem, lowering it provides no benefit and statins have been shown to produce a large and growing list of problems. Also, the weak association between LDL and CVD goes away completely if one has fairly high HDL and low trigs, and/or fairly low fasting insulin.

The major point in all of this is that there are much more impactful things to do to reduce the chance of CVD, specifically keeping fasting insulin low, keeping blood sugar spikes to a minimum, getting sun exposure, and all the other things Dr. Kendrick and others have described.
 

Vince

Super Moderator
Death by all causes seems a more important number - if you look at statins and see that the heart attack rate goes down on statins - yet the death-by-all-causes hardly budges, it is easy to understand that statins do some kind of harm in exchange for the good.
We really don't know what Statins do for folks on a low-carb diet - is it net harm or net good?
Consider the Simpson's paradox - Wikipedia
I suspect that for people that closely control their BG, that Statins have a smaller benefit.
 

jdthoosier

Active Member
I'm not going to plow through 30,000+ studies on statins on Pubmed nor am I intending to defend statins.

I'm merely pointing out this headline for this topic: ""No evidence exists to prove that having high levels of bad cholesterol causes heart disease, leading physicians have claimed" is bogus. Try googling that group "International Group of Cholesterol Skeptics" and find their history. Read the criticism/skepticism of this group. These guys go back for a while, e.g., 2008:

The International Network of Cholesterol Skeptics

They have the same old shtick used by the woo industry: sensational headlines, Big Pharma conspiracies, cherry-picking, distortion, and poorly written, non-peer reviewed "studies".

The formation of THINCS was apparently inspired by Ravnskov's book, published under the English title of The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease in 2000. Although respected as an authoritative guidebook for cholesterol "skeptics", this work engages in fallacies and deceptive rhetoric.

Ravnskov misinterprets the term "cause" in a scientific context (hint: it does not mean "sufficient condition"), and thus, systematically argues against a strawman position that respectable scientists don't even hold - i.e. that the amount and type of dietary fat is the only factor determining blood cholesterol, which in turn is the only determinant of atherosclerosis and heart disease, and no other factor matters. Accordingly, at one point, he interprets a statistic of only 80% and not 100% of heart attack deaths being in people with atherosclerosis as a vindication of his theory (it's not.)

Similarly, in citing the Framingham Heart Study and the declining rate of heart-disease mortality in Japan since 1970, he conflates correlation with causation to support his hypothesis that high cholesterol is actually beneficial, while ignoring confounding factors such as malnourishment or chronic illness that simultaneously lower both blood cholesterol and general health outcomes.
 

Vince

Super Moderator
I always believed the only benefit of Statins is to help stabilize your artery plaque but it doesn't stop the growth artery plaque.
 
M

MarkM

Guest
The first time I had my cholesterol tested as part of a basic blood work up was in 2006. My Total Cholesterol was LDL was 294, and HDL was 4. The doctor came unglued and said, "Son, you are about to have a massive coronary." I tried numerous statins and all of them raised my liver enzymes to extremely high levels and the doctor told me I was not a candidate for statins due to the damage being done to my liver. He told me he wasn;t sure what I could do except improve my diet but there was no way I would be able to get it down to "normal" levels.

That was 12 years ago. My last blood work in August showed my Total Cholesterol at 142, LDL at 89, and HDL of 40, and VLDL at 13. Quite a reduction without any type of prescribed medication.

However, I do take the following supplements:
Extra Virgin Olive Oil - one "shot" every day
DHA
MCT Oil
Niacin
Olive Leaf Extract

I don't think I'm much different than the average person so it is possible to bring cholesterol levels down without statins. I've read numerous bad things about statins and for me, I am glad I am not having to take them.
 

jdthoosier

Active Member
I always believed the only benefit of Statins is to help stabilize your artery plaque but it doesn't stop the growth artery plaque.

I think statins have their place, but I would do everything I could to avoid having to take them, just as I would for anything such as blood pressure pills, PPIs, etc.

About statins reducing mortality, I came on this searching the NY Times:

https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.14993

Conclusions
Statin use was associated with a significant lower risk of mortality in older male physicians ≥70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.

There's thousands of other studies out there. And that is the problem - people have agendas and they cherry-pick/confirmation bias those studies that supports their agendas while ignoring the studies that contradict.

Which is why I'm highly skeptical of big claims.
 
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