Challenging the Cholesterol Hypothesis

ACCELERATE Trial – Lowering LDL Ineffective

“The recently presented ACCELERATE . . . [failed] to demonstrate any cardiovascular benefit of evacetrapib despite dramatically lowering low-density lipoprotein cholesterol . . .This clinical trial adds to a growing volume of knowledge that challenges the validity of the cholesterol hypothesis and the utility of cholesterol as a surrogate end point.”

– Cholesterol paradox: a correlate does not a surrogate make, Robert DuBroff, Evidence-based medicine, 2(1) December 2016.

http://ebm.bmj.com/content/22/1/15  Full text: http://tinyurl.com/ydh9k2vn

As Many CAD Patients Have Low-LDL as Not

“In a large cohort of patients hospitalized with CAD [136,905], almost half have admission LDL levels <100 mg/dL.” [Note: Almost 75 percent of heart attack patients fell within recommended targets for LDL cholesterol.]

– Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines, American Heart Journal, Volume 57, Issue 1, January 2009.

https://www.sciencedirect.com/science/article/pii/S0002870308007175

LDL-C Does Not Cause CVD – A Comprehensive Review

“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), . . . However, there is an increasing understanding that the mechanisms are more complicated, . . .”

LDL-C Does Not Cause Cardiovascular Disease: a comprehensive review of current literature, Uffe Ravnskov, et. al., Expert Review of Clinical, Volume 11, 2018, Issue 10.

https://www.tandfonline.com/doi/abs/10.1080/17512433.2018.1519391

Lowering LDL-C Inconsistent Results

“...focusing almost exclusively on lowering LDL-C for everyone does not consistently work... Our LDLC-centric approach to cardiovascular disease prevention may have distracted us from investigating other pathophysiologic mechanisms and treatment...”

– A Reappraisal of the Lipid Hypothesis, Robert DuBroff, MD, The American Journal of Medicine, September 2018, Volume 131, Issue 9.

https://www.amjmed.com/article/S0002-9343(18)30404-2/fulltext


LDL Hypothesis – Pro and Con – by Ivor Cummins

LDL-C Pros and cons

Click to see larger image in new window or view as PDF (new window). This table was put together by and is used with the permission of Ivor Cummins. Check out his excellent podcasts.


Continue onto: Other Surrogate Markers than TC or LDL-C
Return to: High Cholesterol is Neutral or Beneficial for the Elderly
Begin again at: Introductory Explanation

—> View as PDF (new window) <—