According to this study (Framingham data):
Increased Small Low-Density Lipoprotein Particle Number
Compared with participants without the MetSyn [Metabolic Syndrome], those with the MetSyn had a higher CVD [Cardio Vascular Disease] event rate. However, among participants with the MetSyn, CVD rates were similar for groups with an elevated versus a lower number of small LDL particles (defined by the sex-specific median).
Conclusions— Small LDL particle number is elevated in the MetSyn, increases with the number of MetSyn components, and most prominently is correlated with triglycerides and HDL-C. Whereas increased small LDL particle number identified the MetSyn with high sensitivity, a higher small LDL particle number was not associated with greater CVD event rates in people with the MetSyn.
Putting it in simple terms: the common misconception that LDL correlates with cardio-vascular disease was caused by bad math! LDL correlated with MetSyn and MetSyn correlates with CVD. Medical establishment leaders with insufficient mathematical training incorrectly believed that correlation supposedly follows the "The law of syllogism" (i.e. if LDL → MetSyn and MetSyn → CVD then LDL → CVD) - BUT IT DOES NOT!
That study simply proved it by finding that in the sub-population of people who already had MetSyn, the number of small LDL particles did not matter! Cholesterol theory is very dead and thoroughly debunked, case closed! Fire them all and move on, next myth please...
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8 comments :
Nice!
What happens with CVD rates in those without MetSyn, at various LDL levels? Don't you think this information is necessary to be as affirmative as you are?
No it is not necessary, there is enough other evidence to corroborate that view. Though I would not be surprised if there were some weak and spurious correlation in that group.
Non-MetSyn group have much lower risk of CVD, by a large factor. Within this group, LDL may be a measure of a of progression towards metabolic syndrome, since the presence of small dense LDL particles (and high triglycerides) indicates a high carbohydrate high caloric diet.
High blood glucose levels in conjunction with high insulin levels seems to be the direct triggers of atherosclerosis while LDL is a spurious distraction, in my opinion. See also this:
INSULIN STIMULATION OF CHOLESTEROL SYNTHESIS BY ARTERIAL TISSUE, R.W.STOUT
INSULIN-STIMULATED LIPOGENESIS IN ARTERIAL TISSUE IN RELATION TO DIABETES AND ATHEROMA, R.W.STOUT
Thanks for your answer (and the links), Stan. I agree that a "high carbohydrate high caloric diet" is a very bad idea ;-)
Thanks for the links. Brilliant! I have crohn's, and atherosclerosis occurs with depressed serum chol and LDL. The first link explains a very interesting and possible mechanism independent of serum chol- especially as hyperinsulinemia is characteristic.
I used to work with the wife of one hospital's chief cath lab nurse, who spent every day for more than 20 years looking at people's arteries. His conclusion based on his observations during that time was that cholesterol levels had nothing to do with heart disease/plaque formation. He himself believed it must be "genetic" (which I find many people turn to as a patsy/easy answer for such things). We know better, of course, but his observations are indicative of what you're saying, Stan.
Arteriosclerosis does reverse on a ketogenic diet. This has been tested more practically, by a medical team in Lodz (Poland around 1979-1980) in a cardiac ward. Out of 50 patients waiting for bypass surgery, only 1 worsened, the rest improved to the stage when they declined the surgery. The patients then continued the diet after being discharged and at the time when that personal communication report was disclosed, 20 years later, they were said to be all alive. They used dr. Kwasnieski's "Optimal Diet" which is 1g of protein, 1.5-2.5g of fat and 0.5g carbs per 1kg of ideal body weight, per day. I personally met one such cardiovascular recovery person in Toronto.
Sine,
Crohn's disease was our first practical experience of our heresy. Around year 2000 my wife met our friend's daughter, a girl in her late 20-ties with a very severe condition. She was comming back from Texas visiting her in-laws (top medical doctors in TX). She came back to Toronto, in a wheelchair, too weak to walk. She was about 6' tall and weighed below 50kg. My wife visited her, brought a tub of 30% cream and said "drink it" completely turning her life around. A few years later, healthy with a new husband and children...
Stan
I should note the article you linked is about ten years old. I wonder what Chris Masterjohn would think of it.
I remember sometime back, Peter at Hyperlipid mentioned a woman with a "sensible eating pattern" who nonetheless had a predominance of small, dense LDL particles. She also had an EBCT score of 0 or no evidence of heart disease. That alone says there's something more going on with CVD than LDL.
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