Is LDL Bad?
The gold standard of hammering down the cholesterol may be in question…..again. A new study may show that there could be a correlation between a low LDL and cancer. Others study have shown this but there was some confusion about whether it was related to the medicine people were taking. In this study, no one was on meds and the relationship was still there. Wow. This is all still preliminary but it will send shockwaves around the medical world. Remember, our first job is to do no harm. Maybe we need to take this out of the cardiologists’ hands and look at the use of statins from a 30,000 feet level? LDL is not bad. Small, dense LDL is bad. Bad diets lead to LDL being oxidized from a fluffy buoyant configuration to a small, dense one. Maybe we need to stop estimating LDL and directly measure small, dense LDL to get a better studies?
how about this for a 30,000ft view:
1.the study linking cholesterol to heart disease was done by keys, called the seven countries study. too bad the study was originally done in 15 countries, and 8 of the countries that were studied showed no correlation between cholesterol and heart disease and were consequently omitted.
2.cholesterol has also been shown to be protective against death from sepsis is some animal models
3.while there are studies showing secondary prevention works, they have never actually treated based on an LDL level, but rather whether or not you had an MI or stroke.
4.there are two trials done on primary prevention, one done in japan (therefore likely not applicable to the us and done with pravastatin) and the other (jupiter) that was stopped early before regression to the mean had erased any slight mortality benefit that it showed
5.noone has prospectively validated framingham in a study and proven mortality reduction
6.all other cholesterol medicines, diets and such have shown NO mortality benefit, ever.
7.even if JUPITER were true, it would cost $600,000 per life saved if we followed that protocol for prevention. the current set point for efficacy is ~$150,000.
so, as George Carlin would have said, “We made the whole f*&^%$g thing up! Aren’t we versatile?”
Read about it more in the Scandinavian Cardiovascular Journal. A fine, nondrug company, non conflicted publication.