01/28/2025
Folks seem to like study posts. Here are some studies questioning what we thought we knew about cholesterol.
“A conclusive association between absolute reductions in LDL-Colesterol levels and individual clinical outcomes was not established, and these findings underscore the importance of discussing absolute risk reductions when making informed clinical decisions with individual patients.” 21 clinical trials were used in this systematic meta analysis, considering 140,000 individuals. This is the largest meta analysis on this subject, also published in one of the most reputable journals.
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Byrne, P. Demasi, M. Jones, M. Smith, S. O’Brien, K. DuBroff, R. (2022). Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment. JAMA Internal Med.
Conclusion: “Long-term follow-up findings showed that low LDL-c levels may predict a less favorable outcome in advanced heart failure, particularly in patients< 70 years old and those taking statins. This negates the protocol of following an aggressive LDL-c-lowering strategy in younger patients with heart failure.”
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Charach, G., Argov, O., Nochomovitz, H., Rogowski, O., Charach, L., & Grosskopf, I. (2018). A longitudinal 20 years of follow up showed a decrease in the survival of heart failure patients who maintained low LDL cholesterol levels. QJM: An International Journal of Medicine, 111(5), 319-325.
“The lowest LDL-C group (LDL< 70 mg/dL) had a higher risk of all-cause mortality (HR 1.95, 1.55–2.47), CVD mortality (HR 2.02, 1.11–3.64), and cancer mortality (HR 2.06, 1.46–2.90) compared to the reference group (LDL 120–139 mg/dL).”
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Sung, K. C., Huh, J. H., Ryu, S., Lee, J. Y., Scorletti, E., Byrne, C. D., ... & Ko, S. B. (2019). Low Levels of Low-Density Lipoprotein Cholesterol and Mortality Outcomes in Non-Statin Users. Journal of Clinical Medicine, 8(10), 1571.
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Ravnskov, U., Diamond, D. M., Hama, R., Hamazaki, T., Hammarskjöld, B., Hynes, N., ... & Sundberg, R. (2016). Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ open, 6(6), e010401.
“A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD.”
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Siri-Tarino, P. W., Sun, Q., Hu, F. B., & Krauss, R. M. (2010). Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. The American journal of clinical nutrition, 91(3), 535-546.
“Whole-fat dairy, unprocessed meat, eggs and dark chocolate are saturated fat-rich foods with a complex matrix that are NOT associated with increased risk of CVD. The totality of available evidence does not support further limiting the intake of such foods.”
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Astrup, A., Magkos, F., Bier, D. M., Brenna, J. T., de Oliveira Otto, M. C., Hill, J. O., ... & Yusuf, S. (2020). Saturated Fats and Health: A Reassessment and Proposal for Food-based Recommendations: JACC State-of-the-Art Review. Journal of the American College of Cardiology.
“Extensive research did not show evidence to support a role of dietary cholesterol in the development of CVD. As a result, the 2015–2020 Dietary Guidelines for Americans (U.S. Department of Health and Human Services) removed the recommendations of restricting dietary cholesterol to 300 mg/day.”
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Soliman, G. (2018). Dietary cholesterol and the lack of evidence in cardiovascular disease. Nutrients, 10(6), 780.
Researchers at Boston University studied data on more than 2,300 adults and found that eating five or more eggs a week was associated with lower blood pressure, lower blood sugar, and a lower risk of type 2 diabetes, suggesting eating eggs may actually promote heart health.
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Mott, M. M., Zhou, X., Bradlee, M. L., Singer, M. R., Yiannakou, I., & Moore, L. L. (2023). Egg Intake Is Associated with Lower Risks of Impaired Fasting Glucose and High Blood Pressure in Framingham Offspring Study Adults. Nutrients, 15(3), 507.
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The Minnesota Coronary Survey was a 4.5-year, open enrollment, single end-time, double-blind, randomized clinical trial that was conducted In six Minnesota state mental hospitals and one nursing home. It Involved 4393 Institutionalized men and 4664 Institutionalized women. This trial compared a high LDL cholesterol diet with a low LDL cholesterol diet. There were “no differences between the treatment and control groups were observed for cardiovascular events, cardiovascular deaths, or total mortality.” HOWEVER the low LDL cholesterol did have a significant increase in cancer diagnosis.
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McGovern, P. G., Jacobs Jr, D. R., Shahar, E., Arnett, D. K., Folsom, A. R., Blackburn, H., & Luepker, R. V. (2001). Trends in acute coronary heart disease mortality, morbidity, and medical care from 1985 through 1997: the Minnesota heart survey. Circulation, 104(1), 19-24.
