new research on cholesterol and heart disease

Link between high cholesterol and heart disease 'inconsistent', new study finds

New research from RCSI University of Medicine and Health Sciences has revealed that the link between 'bad' cholesterol (LDL-C) and poor health outcomes, such as heart attack and stroke, may not be as strong as previously thought.

Published in JAMA Internal Medicine , the research questions the efficacy of statins when prescribed with the aim of lowering LDL-C and therefore reducing the risk of cardiovascular disease (CVD).

Previous research has suggested that using statins to lower LDL-C positively affects health outcomes, and this is reflected in the various iterations of expert guidelines for the prevention of CVD. Statins are now commonly prescribed by doctors, with one third of Irish adults over the age of 50 taking statins, according to previous research.

The new findings contradict this theory, finding that this relationship was not as strong as previously thought. Instead, the research demonstrates that lowering LDL-C using statins had an inconsistent and inconclusive impact on CVD outcomes such as myocardial infarction (MI), stoke, and all-cause mortality.

In addition, it indicates that the overall benefit of taking statins may be small and will vary depending on an individual's personal risk factors.

The lead author on the paper is Dr Paula Byrne from the HRB Centre for Primary Care Research based in RCSI's Department of General Practice. Commenting on the findings, Dr Byrne said: "The message has long been that lowering your cholesterol will reduce your risk of heart disease, and that statins help to achieve this. However, our research indicates that, in reality, the benefits of taking statins are varied and can be quite modest."

The researchers go on to suggest that this updated information should be communicated to patients through informed clinical decision-making and updated clinical guidelines and policy.

This important discovery was a collaboration with Professor Susan M Smith, also of RCSI and with researchers from the University of New Mexico, USA, (Dr Robert DuBroff), the Institute for Scientific Freedom in Denmark (Dr Maryanne Demasi), Bond University in Australia (Dr Mark Jones) and independent researcher Dr Kirsty O'Brien.

Cholesterol
Heart Disease
Stroke Prevention
Diseases and Conditions
Multiple Sclerosis
Alzheimer's
Low density lipoprotein
Ischaemic heart disease
Double blind
COX-2 inhibitor
Health science

Story Source:

Materials provided by RCSI . Note: Content may be edited for style and length.

Journal Reference :

Paula Byrne, Maryanne Demasi, Mark Jones, Susan M. Smith, Kirsty K. O’Brien, Robert DuBroff. Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment . JAMA Internal Medicine , 2022; DOI: 10.1001/jamainternmed.2022.0134

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LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature

Affiliations.

1 a Independent investigator , Lund , Sweden.
2 b Laboratoire Coeur et Nutrition, TIMC-IMAG, School of Medicine , University of Grenoble-Alpes , Grenoble , France.
3 c Department of Molecular Pharmacology and Physiology, Center for Preclinical and Clinical Research on PTSD , University of South Florida , Tampa , FL , USA.
4 d Department of Psychology, Center for Preclinical and Clinical Research on PTSD , University of South Florida , Tampa , FL , USA.
5 e Japan Institute of Pharmacovigilance , Osaka , Japan.
6 f Department of Internal Medicine, Toyama Jonan Onsen Daini Hospital , University of Toyama , Toyama , Japan.
7 g Strömstad Academy , Strömstad , Sweden.
8 h Western Vascular Institute, University Hospital Galway & Galway Clinic , National University of Ireland & Royal college of Surgeons of Ireland affiliated Hospital , Galway , Ireland.
9 i East Cheshire Trust, Macclesfield District General Hospital , Macclesfield , UK.
10 j Private Practice in Cardiology , Tyler , Texas , USA.
11 k Medical Service , Comando Brigata Alpina "Julia"/Multinational Land Force , Udine , Italy.
12 l Pathology and Laboratory Medicine Service, VA Boston Healthcare System West Roxbury , Harvard Medical School , Boston , MA , USA.
13 m Faculty of Pharmaceutical Science , Nagoya City University , Mizuhoku, Nagoya , Japan.
14 n New York Medical College , The American Institute of Stress , New York , NY , USA.
15 o Wallenberg Laboratory for Cardiovascluar and Metabolic Research, Sahlgren's Academy , University of Gothenburg , Gothenburg , Sweden.
16 p Department of Metabolism , Columbia University , New York , NY , USA.
17 q Independent Researcher , Lidingö , Sweden.
PMID: 30198808
DOI: 10.1080/17512433.2018.1519391

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.

Keywords: Atherosclerosis; cardiovascular; cholesterol lowering; coronary heart disease; exposure–response; mortality; statin.