9 ms·

The reason this is published in an ancillary journal is that it is a polemic that pushes an agenda beyond where the data support. Much of what is written here

The reason this is published in an ancillary journal is that it is a polemic that pushes an agenda beyond where the data support. Much of what is written here is accepted widely: that many types of fats are not really the issue driving heart disease; that fructose and other sugars are problematic; that lifestyle interventions can have a real impact; that stenting stable atherosclerosis has no benefit; and that atherothrombosis is the killer. The ongoing effort by these authors to dismiss the LDL hypothesis weakens this paper. That LDL is a primary contributor to cardiovascular disease, myocardial infarction, and death is supported by human genetic data and by hundreds of thousands of individuals followed in clinical trials, as well as millions of people in post marketing monitoring. The casual dismissal in this article by referring to low quality, confounded evidence (observational studies) is not responsible and it taints an otherwise useful summary.

riahi 9y ago
Agree. To give context, this is an editorial in a sports medicine journal. It's not a trial, meta-analysis, or even a systematic review.
- abainbridge 9y ago
  No, but the first reference is to, "A landmark systematic review and meta-analysis of observational studies showed no association between saturated fat consumption and (1) all-cause mortality, (2) coronary heart disease (CHD), (3) CHD mortality, (4) ischaemic stroke or (5) type 2 diabetes in healthy adults." Which you can find here: http://www.bmj.com/content/351/bmj.h3978 http://www.bmj.com/content/351/bmj.h3978
  - YeGoblynQueenne 9y ago
    The reference concludes that trans fats are bad for you and that the evidence for saturated fats not being bad for you is not complete: Conclusions Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations. Trans fats are associated with all cause mortality, total CHD, and CHD mortality, probably because of higher levels of intake of industrial trans fats than ruminant trans fats. Dietary guidelines must carefully consider the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats. Note "but the evidence is heterogeneous with methodological limitations" and "Trans fats are associated with all cause mortality, total CHD, and CHD mortality"
omginternets 9y ago
>The ongoing effort by these authors to dismiss the LDL hypothesis weakens this paper. I didn't get the sense that they were being dismissive, so much as pointing out that the risk has been exaggerated.
- carbocation 9y ago
  They are claiming that the risk has been exaggerated, but they are using low quality evidence to support that claim. Higher quality evidence differs.
  - deleted 9y ago
    [deleted]
- pascalxus 9y ago
  They did a whole lot more than try to dismiss it. They said it was "inversely related". Here's a quote: "a recent systematic review concluded that LDL cholesterol is not associated with cardiovascular disease and is inversely associated with all-cause mortality" This goes directly against everything the AHA says and what countless other sources are saying.
beagle3 9y ago
Dietary phytosterols lower cholesterol but do not reduce CVD or all cause mortality[0]. I don't remember the other names, but phytos are just one of many classes of agents that have been shown to reduce cholesterol without any other beneficial effect; IIRC, other than statins, there is only one other class of drugs that reduces cholesterol and reduces CVD. LDL correlates trouble, but evidence that it is part of the problem when I last looked was not well supported (though it is generally accepted in the medical community) [0] https://en.wikipedia.org/wiki/Phytosterol#Cholesterol_lowering https://en.wikipedia.org/wiki/Phytosterol#Cholesterol_loweri...
justinjlynn 9y ago
> The reason this is published in an ancillary journal is that it is a polemic that pushes an agenda beyond where the data support. If this is the case, then it shouldn't be published in any reputable journal outside of a very clearly marked "opinion" or "editorial" column.

riahi 9y ago

Agree. To give context, this is an editorial in a sports medicine journal. It's not a trial, meta-analysis, or even a systematic review.

abainbridge 9y ago
No, but the first reference is to, "A landmark systematic review and meta-analysis of observational studies showed no association between saturated fat consumption and (1) all-cause mortality, (2) coronary heart disease (CHD), (3) CHD mortality, (4) ischaemic stroke or (5) type 2 diabetes in healthy adults." Which you can find here: http://www.bmj.com/content/351/bmj.h3978 http://www.bmj.com/content/351/bmj.h3978
- YeGoblynQueenne 9y ago
  The reference concludes that trans fats are bad for you and that the evidence for saturated fats not being bad for you is not complete: Conclusions Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations. Trans fats are associated with all cause mortality, total CHD, and CHD mortality, probably because of higher levels of intake of industrial trans fats than ruminant trans fats. Dietary guidelines must carefully consider the health effects of recommendations for alternative macronutrients to replace trans fats and saturated fats. Note "but the evidence is heterogeneous with methodological limitations" and "Trans fats are associated with all cause mortality, total CHD, and CHD mortality"

omginternets 9y ago

>The ongoing effort by these authors to dismiss the LDL hypothesis weakens this paper. I didn't get the sense that they were being dismissive, so much as pointing out that the risk has been exaggerated.

carbocation 9y ago
They are claiming that the risk has been exaggerated, but they are using low quality evidence to support that claim. Higher quality evidence differs.
- deleted 9y ago
  [deleted]
pascalxus 9y ago
They did a whole lot more than try to dismiss it. They said it was "inversely related". Here's a quote: "a recent systematic review concluded that LDL cholesterol is not associated with cardiovascular disease and is inversely associated with all-cause mortality" This goes directly against everything the AHA says and what countless other sources are saying.

beagle3 9y ago

Dietary phytosterols lower cholesterol but do not reduce CVD or all cause mortality[0]. I don't remember the other names, but phytos are just one of many classes of agents that have been shown to reduce cholesterol without any other beneficial effect; IIRC, other than statins, there is only one other class of drugs that reduces cholesterol and reduces CVD. LDL correlates trouble, but evidence that it is part of the problem when I last looked was not well supported (though it is generally accepted in the medical community) [0] https://en.wikipedia.org/wiki/Phytosterol#Cholesterol_lowering https://en.wikipedia.org/wiki/Phytosterol#Cholesterol_loweri...

justinjlynn 9y ago

> The reason this is published in an ancillary journal is that it is a polemic that pushes an agenda beyond where the data support. If this is the case, then it shouldn't be published in any reputable journal outside of a very clearly marked "opinion" or "editorial" column.