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Sebastian Rushworth MD: Is the cholesterol hypothesis dead?

See my previous posts on statins and cholesterol.

The modern medical establishment continues to do massive harm to a large segment of the population at enormous cost.

Sebastian Rushworth MD: Is the cholesterol hypothesis dead?

by Sebastian Rushworth M.D, Sept 8 2020

Is there any life left in the cholesterol hypothesis (a.k.a. the lipid hypothesis)? Is there anything left for serious scientists to cling to or is time for its mouldering corpse to end up on the trash heap of medical history, alongside lobotomy, bloodletting and the theory of the four humors? I was asked this question by a reader of this blog recently, and as it happens, a systematic review was recently published in Evidence Based Medicine (my favorite medical journal, mainly because it is edited by the brilliant Dr. Carl Heneghan) that definitively answers this question, so I thought it would be interesting to go through what the evidence says together.

As many readers will be aware, the cholesterol hypothesis is the idea that cardiovascular disease is caused by high levels of cholesterol in the blood stream. The hypothesis harks back to the early part of the twentieth century, when a Russian researcher named Nikolai Anitschkow fed a cholesterol rich diet to rabbits and found that they developed atherosclerosis (hardening of the arteries, the process which in the long run leads to cardiovascular disease)[WIND: rancid cholesteral, with damaged molecules]. Of course, rabbits and humans are very different species, with very different dietary preferences. Rabbits, being herbivores, normally have very little cholesterol in their diets, while humans, being omnivores, generally consume quite a bit of cholesterol. Regardless, the data was suggestive, and led to the hypothesis being formulated.

...Clearly, if the cholesterol hypothesis is true, then the amount of benefit seen from lowering LDL should stand in direct proportion to the amount by which LDL is lowered, right? Anything else would be illogical.

...

...the cholesterol hypothesis is dead, dead, dead. There is no correlation between effect on LDL and effect on mortality. Anyone who still chooses to cling to the cholesterol hypothesis in spite of this is consciously refusing to see what a vast amount of high quality scientific evidence is putting right in front of their eyes.

Secondly, as an interesting aside, only 5 out of 35 trials found a mortality benefit, which means that 30 out of 35 did not find any benefit. And yet somehow statins are one of the most widely prescribed drugs in the world...

So what are the practical implications for you as a patient? As I mentioned in an earlier article, there is no point getting your cholesterol levels tested, because they tell you nothing about your risk of cardiovascular disease. If you are already on a cholesterol lowering drug, and intend to continue for whatever reason, there is no point doing annual check-ups of your cholesterol levels, because there is no correlation between how much the drug lowers those levels and your risk of future cardiovascular events. And there is certainly no point in trying to reach a “target” LDL level.

WIND: R.I.P statins and cholesterol.

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