Introduction: For half a century, a high level of total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated and that statin treatment, in particular when used as primary prevention, is of doubtful benefit.

Areas covered: The authors of three large reviews recently published by statin advocates have attempted to validate the current dogma. This article delineates the serious errors in these three reviews as well as other obvious falsifications of the cholesterol hypothesis.

Expert commentary: Our search for falsifications of the cholesterol hypothesis confirms that it is unable to satisfy any of the Bradford Hill criteria for causality and that the conclusions of the authors of the three reviews are based on misleading statistics, exclusion of unsuccessful trials and by ignoring numerous contradictory observations.

Full Paper: https://doi.org/10.1080/17512433.2018.1519391

  • jet@hackertalks.comOPMEnglish
    1·
    2 months ago

    idee fixee

    Great phrase! new to me, I had to look it up. For what it’s worth, I don’t have any personal investment in the LDL debate. My LDL falls in the recommended guideline ranges anyway. https://hackertalks.com/post/6749910

    I’m just curious.

    significant contributing factor…It is well known that some people with elevated LDL or total cholesterol are at low risk

    statin use in select patients reduces the risk of MI and CVA

    I think your statements and the paper are congruous. The target audience for the paper are the people who treat LDL in isolation.

    It does appear that Targher et al do agree with your concerns of the paper: https://doi.org/10.1080/17512433.2019.1561100

    We strongly believe that it is not sufficient to say ‘a high LDL-cholesterol level always or never causes CVD events and mortality!’. Binary interpretations of the data in biology and medicine are far too simplistic an approach.

    My understanding of Ravnskov’s commentary in the LDL-C paper is not that statins have no value in all circumstances, but that diet and lifestyle treatments (he implies, but does not say explicitly) would have more impact in isolation then statins in isolation especially in contexts where LDL is the only presenting risk factor.

    Ravnskov does state that there is a significant relative risk reduction with a statin, but the absolute risk reduction isn’t significant. Ravnskov’s commentary about the pre-study washout skewing results would apply to the meta-analysis and Cochrane review below

    Efficacy and safety of long-term treatment with statins for coronary heart disease: A Bayesian network meta-analysis (2016)

    I couldn’t get access to the supplement section to see the list of studies included to compare against Ravnskovs included studies, but the papers mortality numbers are all presented in RR terms.

    Statins for the primary prevention of cardiovascular disease

    It appears that only RR is computed.

    Caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk.

    Ravnskov does include many of the studies from Figure 1.

    Furthermore, two of the larger trials were prematurely stopped because significant reductions in primary composite outcomes had been observed…Early stopping of trials is of particular concern because in this and other situations early stopping may lead to an over-estimation of treatment effects particularly when the number of events is small

    Caution also needs to be taken regarding the fact that all but one of the trials had some form of pharmaceutical industry sponsorship.

    Widespread use of statins in people at low risk of cardiovascular events - below a 1% annual all-cause mortality risk or an annual CVD event rate of below 2% observed in the control groups in the trials considered here - is not supported by the existing evidence. Furthermore, the tendency of trial protocols to remove patients suffering with comorbidities limits their generalisability to typical patient populations in whom decisions to prescribe statins have to made.

    This is also a major point Ravnskov makes.

    I really appreciate you reading the paper and giving us your analysis. This is exactly why I come to lemmy.

    I suppose Ravnskov’s new opinion on the EU CVD guidelines would also not be viewed favorably? https://doi.org/10.1080/17512433.2020.1841635

    As far as I’m aware there is no analysis of statins on a healthy adult population, it would be interesting to see. https://doi.org/10.3390/medicina57060585