tweet: “I no longer accept paradigm that high LDL cholesterol causes heart disease” - cardiothoracic surgeon

he doesn’t believe high LDL cholesterol causes heart disease

patients have normal or low cholesterol. cholesterol doesn’t matter?

the paradigm that high LDL cholesterol causes heart disease. Is that the paradigm? No

it’s not high cholesterol that causes heart disease. it’s the lipoproteins that carry cholesterol

vehicles determines plaque/artery blockage, whether lipoproteins have more or less cholesterol

usually if cholesterol is high there are more lipoproteins. if they mismatch, risk follows lipoproteins, not cholesterol level

we can count lipoproteins that cause heart disease with apoB

high apoB + low LDL-c = high risk. apoB causes heart disease. High LDL-cholesterol is an indicator, not the cause

"apoB is a better marker of cardiovascular risk than LDL-cholesterol"

"reframe lipid hypothesis as lipoprotein particle hypothesis"

"lipid hypothesis could be re-examined as lipoprotein hypothesis; risk most proportional to particles, not LDL cholesterol"

evidence for vehicles, against cholesterol as cause; experts don’t think there’s a debate

high LDL-c used as indicator of risk

patients have normal or low LDL-cholesterol so high LDL-cholesterol cant be the cause? are patients on cholesterol-lowering drugs?

Statins lower cardiovascular risk, dont eliminate it, still residual risk. Lowering cholesterol slows buildup of plaque, statins stabilize plaque, there is still plaque burden, statins doesn’t eliminate all plaque

common for someone on statins to have low cholesterol but still have risk of heart attack. risk is lower than with higher cholesterol but still residual risk

cholesterol drops after heart attack (Acute phase response)

"Acute coronary syndrome (heart attack) affects lipids/lipoproteins, low density lipoprotein (LDL) and total cholesterol decrease"

heart attack patients' cholesterol is lower. If i'm not aware of APR i might think "they have low cholesterol, cholesterol level has no relation with heart attacks!"

heart disease: Lipid levels during acute phase after heart attack may not reflect lipid levels leading up to heart attack

cholesterol-lowering drugs and change in lipids in acute phase of disease

threshold for high cholesterol is not where risk starts. the higher your cholesterol the more plaque

normal LDL-c = under100mg/dL, but can have plaque. Less than at 150 but not zero

people with ‘normal’ cholesterol can have plaque, yet high cholesterol is a risk factor

intermediate cholesterol more common

hospitalizations for heart disease + LDL-c levels. cholesterol of 200 is protective? no!!!

more people with cholesterol ~100.

authors: guideline revisions with even lower LDL goals
study: lower LDL cholesterol further

Risk is higher at higher ldl-cholesterol

measure cholesterol before disease. or split randomly, lower cholesterol in half, see who gets heart disease. group that gets drug has lower cholesterol and lower risk. people born with low cholesterol have lower risk of cardiovascular disease and death

LDL-cholesterol = indicator. drugs also lower apoB. if LDL-c and apoB don’t match, risk follows apoB

Bottomline, we don’t ignore high LDL-cholesterol, most of the time it indicates high apoB; if in doubt measure apoB

video: diet to lower apoB

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Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.

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