>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.
No. They’re saying that damage is cumulative over a lifetime - plaque deposition - so that a point in time snapshot of LDL says little about lifetime exposure. If I live my life with high LDL and only get on statins at 65 I might have low LDL when I have a heart attack but the damage came from the decades of high LDL.
The current guidance from the AHA and NLA is that lower is better for as long as possible.
Lower cholesterol helps but lowering inflammation helps everyone. As I’ve said in another comment over 75% of people who have heart attacks have normal LDL levels.
And lower cholesterol is not without its own risks. You need cholesterol to make hormones and things like CoQ10, which are important for our health. So what’s better? Lowering oxidative stress and inflammation or lowering cholesterol?
LDL levels at admittance do not tell us what their lifetime LDL levels were. But even your own link is arguing for lowering the the number at which we consider LDL levels risky.
PCSK9 inhibitors when coupled with statin therapy have gotten people to ~10 LDL without negative impact in clinical trials. The body is good at producing cholesterol where it needs it - it doesn't pass the blood brain barrier, yet the brain is full of it. It produces it's own, the same as quite a lot of other tissue
For hormones, de novo synthesis of cholesterol is a thing when it comes to steroidgenesis, as well as recycling and re-uptake. PCSK9 inhibitor studies specifically looked at this because of this concern, and found cortisol/aldosterone/testosterone/estrogen/etc. were not impacted by having very lower levels of LDL-C.
The issue with statins and CoQ10 isn't cholesterol - it's the mevalonate pathway. They block a reductase in the pathway and this results in lower serum CoQ10 levels. Data around if this is of any clinical relevance is a mixed bag, but this is easily supplementable if needed, and should not be a reason to not take life saving medication. PCSK9 inhibitors make large dents in LDL but do not impact CoQ10 levels at all because they do not impact the mevalonate pathway.
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.