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tweet: “I no longer accept paradigm that high LDL cholesterol causes heart disease” - cardiothoracic surgeon Uploaded 05-01-22he doesn’t believe high LDL cholesterol causes heart diseasepatients 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 cholesterolvehicles determines plaque/artery blockage, whether lipoproteins have more or less cholesterolusually 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 apoBhigh 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 debatehigh LDL-c used as indicator of riskpatients 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 plaquecommon 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 riskcholesterol 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 attackcholesterol-lowering drugs and change in lipids in acute phase of diseasethreshold for high cholesterol is not where risk starts. the higher your cholesterol the more plaquenormal LDL-c = under100mg/dL, but can have plaque. Less than at 150 but not zeropeople with ‘normal’ cholesterol can have plaque, yet high cholesterol is a risk factorintermediate cholesterol more commonhospitalizations for heart disease + LDL-c levels. cholesterol of 200 is protective? no!!!more people with cholesterol ~100.authors: guideline revisions with even lower LDL goalsstudy: lower LDL cholesterol furtherRisk is higher at higher ldl-cholesterolmeasure 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 deathLDL-cholesterol = indicator. drugs also lower apoB. if LDL-c and apoB don’t match, risk follows apoBBottomline, we don’t ignore high LDL-cholesterol, most of the time it indicates high apoB; if in doubt measure apoBvideo: diet to lower apoBConnect with me:Facebook: https://www.facebook.com/DrGilCarvalho/Twitter: https://twitter.com/NutritionMadeS3Animations: Even Topland @toplandmediaReferences:https://jamanetwork.com/journals/jama/fullarticle/2650885https://www.pnas.org/content/pnas/77/1/604.full.pdfhttps://jamanetwork.com/journals/jamacardiology/fullarticle/2786334https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.112.101782https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3322446/https://www.sciencedirect.com/science/article/pi Learn more about your ad choices. Visit megaphone.fm/adchoices
