Thinking About the Cholesterol Controversy

There’s an article at Science-based-Medicine on the controversies associated with cholesterol that I found interesting and wanted to commend to your attention. Unsurprisingly, it reaches the conclusion that high cholesterol is bad for you:

We have moved past diet studies for lowering cholesterol. Women are included in studies. There is a mortality benefit. Statins (and other medications) do work by lowering LDL. Statins are now generic. There are alternative to statins if you have side effects. The thing about the cholesterol controversy is that most of it has been settled.

Some issues remain. Maybe it is better to measure to non-HDL cholesterol or ApoB cholesterol instead of LDL cholesterol. But this is a subtle point, and finding a better way to measure something does not negate the underlying truth that high cholesterol increases the risk of heart disease.

There was a time when someone could be skeptical about the role of cholesterol in cardiac risk reduction. That time has now past.

but some of the other observation may (or may not) surprise you for example that diet studies are by and large terrible and that the populations in drug trials haven’t been random sample, indeed, have been very biased. I don’t think that the author addresses that issue enough. Historically, the participants in early drug trials have overwhelmingly been white middle-aged men, frequently from within single social strata.

Some other things that the author touches on but does not consider enough IMO are that we don’t know nearly enough about what is normal or about subgroups within populations.