«

»

May 09

LCCholesterolChallenge Update – The First Contender

It’s hard to believe it was almost three months ago that I posted the #LCCholesterolChallenge and I hadn’t heard a peep. This wasn’t for lack of pinging many of the biggest LDL-lowering experts I could find on Twitter and through social media. In fact, this is the most tweeted and retweeted graphic I’ve used to date.

I’m happy to say we had our first attempt to meet the challenge late last week. Grats to Brian Edwards for giving it a good college try.

He submitted the study, “Coronary Heart Disease Risks Associated with High Levels of HDL Cholesterol”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187512/

So let’s compare the study to each item in the challenge:

“normal, non-treated”

Yes! I’m happy to be looking at neither a drug nor genetic study.

“(1)High HDL”

Yes! This study specifically stratifies for HDL groupings.

“(2)Low Triglycerides”

Alas, no — the study doesn’t stratify for low triglycerides.

While the mean average of triglycerides gets lower with each step higher in HDL, this isn’t the same as categorically excluding higher triglyceride participants from that group. In fact, there certainly were some given the high standard deviation reported. Thus, a few higher risk individuals that would’ve been singled out by this original rule of the challenge could tip the scales.

(3)”High LDL”

No as well. This wasn’t stratified either.

“HIGH RATES OF CARDIOVASCULAR DISEASE”

This one was somewhat odd as Brian seemed very insistent that *any* amount of CAD was a high rate. He pointed out the participants were selected for this study for not having it, yet some developed it on follow up — even in the group with the highest HDL. I definitely felt any reasonable person wouldn’t interpret “any” heart disease as the same as “high” heart disease.

I asked what he’d consider an “average” rate of CAD, leaving it to him to define. Thus, “low” would certainly be below average. Eventually, I offered up:

I’ve already said I’d be happy to accept a reasonable source. Here — the first link under googling, “chd rate by age” is http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_449846.pdf …

Ironically, even in spite of the higher alcoholism, the last two columns shown in the study were still under the average when compared to the heart.org data. So even if TG and LDL had been stratified, the existing rates would still be lower than the mean.

Thus, no — we don’t have high rates of CVD shown. This was actually already alluded to quite a bit from the study’s own graph:

(Click to zoom in)

Third Party Judgement Request

To Brian’s credit, he requested a third party decision and I think Jason gave a very well articulated one:

Brian:

Jason. @DaveKeto doesn’t think I answered the challenge. What do you think? We need a neutral judge. http://meandgin.blogspot.com/2018/05/i-met-low-tg-high-hdlc-high-ldlc.html …

Jason Jodway:

I personally would not say you met the challenge for 2 main reasons: 1) It was never suggested nobody would get CAD. 2) The challenge explicitly states *both* high HDL *and* low TG. That paper doesn’t let us actually stratisfy by that criteria. The trend does not properly

Dialog Paused

I’ll concede this experience was a bit mixed. While I thought we were having a productive dialog (or at least the beginnings of one), I was stunned when Monday morning Brian took to his blog to insist I had made several statements and imposed new requirements that I hadn’t. I brought this to his attention, but he made no effort to correct the record and instead let it stand.

For a brief moment, I was tempted to show Brian’s statements of what I said side-by-side with the actual tweets that were being mischaracterized. But this would just be an investment of time I don’t have. If people are interested, they can look it up themselves.

Thus, for the time being, I’ll have to put this dialog with Brian on pause. I’m kind of a stickler about having an intellectually honest discussion.

Final Thoughts

All things considered, I’m extremely happy Brian has taken part in the challenge and I sincerely congratulate him for giving it a solid try. And of course, I’m certainly looking forward to new challenges — of which I hope there are many!

Leave a Reply

11 Comments on "LCCholesterolChallenge Update – The First Contender"

avatar
  Subscribe  
newest oldest most voted
Notify of
Nick Andre
Guest

If the data, pivoted as you specify, supported the fundamental assertions of the medical community, you probably wouldn’t be writing this blog. As a result, people will provide you data that isn’t aligned on the requirements, is therefore somewhat ambiguous, and go on to argue that it supports their philosophy…somehow. It is but another demonstration of the “loud voices” effect that got us so confused in the first place.

George Henderson
Guest

I suspect we’re at cross purposes with Brian – he thinks this is some ploy to debunk statins and LDL-lowering, when the context is very different.
I’ve looked into abnormally high HDL for no dietary reason before (HALP) and found that the rules there are the same as for high LDL – if you’re insulin sensitive, lean, have low TGs, then HALP is not associated with increased risk of CAD. If you’re IR, it’s another hostage to fortune.

raphael sirtoli
Guest

having interacted with Brian before on Twitter. i’m not surprised this discussion had to be cut short early. as soon as the discussion gets to a crunch point (e.g. black swans) then it’s either radio silence or derision.

statins are medical religion. you can’t expect a rational debate based on irrational axioms.

Brian Scott Edwards MD
Guest

Today is first time I saw this post. I will have to say it is one sided. I also think I am misrepresented on several points. I will pursue it using the document above.

Brian Scott Edwards MD
Guest
He submitted the study, “Coronary Heart Disease Risks Associated with High Levels of HDL Cholesterol” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187512/ So let’s compare the study to each item in the challenge: “normal, non-treated” Yes! I’m happy to be looking at neither a drug nor genetic study. Good. Also patients started out without CAD. “(1)High HDL” Yes! This study specifically stratifies for HDL groupings. Good. “(2)Low Triglycerides” Alas, no — the study doesn’t stratify for low triglycerides. TG were low at 76 in one subgroup Challenge did not ask for stratified data. While the mean average of triglycerides gets lower with each step higher in… Read more »
Brian Scott Edwards MD
Guest

Jason Jodway says 1) “It was never suggested nobody would get CAD.”
Exactly it was not stated in the challenge.
2) The challenge explicitly states *both* high HDL *and* low TG.
Study had TG 76 and HDLc greater than 90. Challenge did not ask for stratification.

Craig Cousineau
Guest

There is absolutely no data that says that anyone with low TG, high HDL, and high LDL is at increased risk of a heart attack. There is no QUALITY data, ie no good science period, that supports the diet heart hypothesis/lipid hypothesis.