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Comment by FollowingTheDao | Hacker News Reader

Yes, LDL is the best we have since they won’t bother to measure oxidative stress nor inflammation in the human body.

But lowering your LDL does not prevent heart disease. There are many many people with normal LDL who have heart attacks.

In fact, it is the norm. And I can’t imagine how many people are being told. They have no heart disease risk just because their LDL is normal. It’s a crime and it needs to be stopped.

https://www.uclahealth.org/news/release/most-heart-attack-pa...

A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.

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> But lowering your LDL does not prevent heart disease. There are many many people with normal LDL who have heart attacks.

Wearing a seatbelt does not prevent death in a car accident. There are many people who wear seatbelts who still perish in car accidents.

While you can find a vocal minority who claim cholesterol is not related to heart disease, the best evidence we have is that it is. A lot of the doctors pushing cholesterol denialism are into quacks, such as Uffe Ravnskov who pivoted from denying a link between LDL and CVD into preaching Vitamin C to treat COVID when that hit the news.

However, it's not the only actor in determining heart attack risk.

Lowering LDL isn't equivalent to a seatbelt. A seatbelt is a safety device that performs a function in an accident.

LDL is used as a predictor because it is easy to measure not because LDL itself causes heart disease. Lowering LDL doesn't actually do anything on its own, because it is just a proxy metric for the underlying problem.

It's more cranky to shutdown discussions by misrepresenting someone's position as "cholesterol denialism". What does that even mean in this context? Finding better predictors is denialism. Great now we just need a ministry of truth.

>Lowering LDL doesn't actually do anything on its own

Is this some sort of weird philosophical statement? Because, of course, it's completely nonsensical, and completely at odds with all data on this file.

Lowering LDL reduces CVD incident rates, with no other interventions. People with genetically low LDL also have lower CVD incident rates. This is extraordinarily well proven.

So it sure seems -- you know, 100% of medical science -- that lowering LDL does "something".

The human body is a complex machine, however, and CVD is multifactorial, and for CVD to develop the current thinking is that you need inflammation and high cholesterol over decades. Inflammation can be caused by things like high blood pressure and the like. But everyone has inflammation to some degree as a facet of living, and the easiest component of that to treat (not just measure) is LDL.

And yes, there is an industry of cholesterol denialists, among whom there are just loads and loads of chiropractors. These clowns have built armies of poorly informed disciples that run to HN to tell us that cholesterol doesn't matter and lowering LDL doesn't do anything.

> People with genetically low LDL also have lower CVD incident rates. This is extraordinarily well proven….. you need inflammation and high cholesterol over decades.

We know that low LDL does not prevent CVD. Therefore we know that you do not need high cholesterol over decades.

Lowering LDL is one of the best preventative measures we have for ASCVD.

https://www.lipidjournal.com/article/S1933-2874%2825%2900317...

That people can still experience a heat attack even with low LDL does not change that fact. We have very large studies showing the efficacy of lowering LDL.

>But lowering your LDL does not prevent heart disease

Literally one of the most proven truths in medical science is that LDL levels has an almost directly relationship with CVD risk over the long term. Someone with low cholesterol can of course still have CVD, but their odds are much better than someone with high cholesterol. And of course the damage from cholesterol is additive, so the earlier you control LDL, the more of a benefit.

>A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.

The damage from high cholesterol happens over decades. Yet the people who actually have heart attacks are often older.

So yes, if gramps spent his life with high cholesterol but now he barely eats and is sedentary, he might have low cholesterol now but that says literally nothing to what you're claiming it does.

Yes, much like wet streets are a high predictor of rain. Or smoke, firefighters and wood are a high predictor of fire. The firefighters are not causing the fire, neither do the wet streets cause rain. This is what people are trying to tell you. If you remove the firefighters only, then you might make it worse. If you do something to cause the firefighters to go away, probably because there isn't a fire anymore, then you did the right thing. The important thing is not to goodhart's law yourself into doing the wrong thing.

This would be a fair analogy if we didn't have studies with a temporal component, but we do. We look at individuals before they get disease then track them over time to see what predicts disease. So we can see, per your analogy, that the fire is there, then the firefighters turn up.

How can inflammation be measured?

I am sure there are other means, but I always thought C-Reactive Protein levels were the standard measure.

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