Hacker News Reader

Comment by atdrummond | Hacker News Reader

Japan has given us some very interesting lipid studies the past few decades.

One continued the analysis of the famous seven countries study, and it found that chronic heart disease rates appear at the least uncorrelated to lipid rates, if not in fact possibly lowered by increased cholesterol: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6086557/

They’ve also confirmed the heart sparing benefits of “good” cholesterol, HDL: https://www.ahajournals.org/doi/full/10.1161/01.STR.00000608...

On top of this, there are numerous studies showing that high total cholesterol (not just HDL) in women is linked to longevity and that perhaps that age and CHD advice on total/LDL cholesterol was only ever relevant for men. (See: https://www.karger.com/Article/Fulltext/342765 for a thoughtful review of current Japanese lipid suggestions and the literature on longevity and vascular disorder.)

View on HN

As has been noted by other authors who have specifically addressed the first article that you cite, Japan's decline in heart disease despite rising cholesterol appears to be due to Japan's reductions in smoking and blood pressure[1]. RCTs have demonstrated, over and over, that reducing LDL cholesterol reduces cardiovascular disease.

1 = https://www.sciencedirect.com/science/article/pii/S016752731...

No, there are RCT that show taking a drug which has the effect of lowering LDL, among many other effects, reduces heart disease. There is no proof that it’s LDL and not something else. And it’s not a coincidence that drugs that help heart disease have intersections with diabetic pathology.

Between randomized trials and Mendelian randomization studies, all of the causal tools demonstrate that LDL is a causal biomarker. (There are other elements in the causal pathway, but very clearly LDL is one of them.)

You are welcome to postulate a different explanation and test that novel mechanism, which is the process of science.

There are numerous examples of people with elevated LDL for years who have zero CAC or no cardiac symptoms. It’s easier to disprove something I admit.

I am still in the process of becoming learned. Eventually I will finish biochemistry, read all the relevant studies and truly get to the bottom of it in a way that is convincing. So even if I am wrong and spreading wrong information I will have a positive contribution in the long term. But I am being intellectually honest always.

The fact that LDL cholesterol is not the only risk factor for heart disease is very well established - just as well established as the fact that LDL cholesterol is a causal risk factor for heart disease. Unfortunately human diseases almost never have a bijective relationship with a risk factor.

Reply on news.ycombinator.com