Friday, October 18, 2019

Total Cholesterol and major cardiovascular events

This is a pure observational study:

Low total cholesterol is associated with increased major adverse cardiovascular events in men aged ≥70 years not taking statins

As such, let's generate an hypothesis.

Let's assume total cholesterol (TC) is utterly, totally and completely meaningless. About anything.

Let's assume that TC is a surrogate for "something" (Something Good) which is really important.

Let's assume that people with high TC are doing something right. Something which the study never even thought about, let alone measured.

Let's assume that statins do absolutely nothing (being generous).

Let's assume people only get put on a statin if their TC is high, ie, they are doing Something Good.

The Something Good behaviour pattern persists despite the statin.

The statination makes the TC number decrease, which makes the statin victims look as if they are doing the Something Bad which, obviously, lowers your TC. But they're not. They do well despite the statin and despite the artificially lowered TC.

EPIC Norfolk suggests looking at HbA1c if you want to look at cardiovascular and all cause mortality. Hints about Something Good here in Norfolk?


Edit: No one (least of all me) would suggest HbA1c elevation is causative of all cause mortality. But at least it starts you looking at the correct metabolic pathways! End edit.


Bob said...

Irony abounds. When I pulled up the abstract I noticed two things.

From the "author affiliations" it appears to be an Australian study. Interesting since Australia is so big on lowering one's cholesterol.

At the end of the article was an ad from Amazon: "COQ10 Supports Heart Health".

Peter said...

Yes. But even in the LC community lowering TC or (gasp) LDLc are considered to be Good Things. I don't mind the veg*ns dropping their cholesterol, the lower the better. But on a norm-insulinaemic diet? Doesn't strike me as anything to celebrate as I inch through my 60s towards geriatricity.


Passthecream said...

Peter, I love this figure-ground reversal, your impeccable logic. Pity that it probably won't lead to a face-palm moment for the True Believers.

Beth said...

If I had to hazard a guess at the Something Good, it might be 'eating saturated fat'. [That would not be the only thing, but one of the things, most likely.]

I just spent a few days with my fat-phobic family, of which I'm the only one that isn't fat. I was also saying to myself that it was such a shame that they were throwing away all that lovely, tasty fat at the dinner table.