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Inflammation now predicts heart disease more strongly than cholesterol
- nikolay 1y agoI am an Empirical Health customer, and the app has numerous bugs. Please, fix them before blogging! Thank you for your attention to this matter. MAKE APPS GREAT AGAIN!
- brandonb 1y agoHi! Happy to help -- can you send me your debugging code (under Settings) if you haven't already? I'm bmb@empirical.health.
- nikolay 1y agoThank you! Just emailed you with the debug code. By the way, on the debug code screen, it says that my push notifications are off, but I was never asked to enable them within the app itself.
- brandonb 1y agoFor decades, LDL cholesterol has been the main target in preventive heart health. The American College of Cardiology just started recommending that everyone measure hs-CRP, a blood test for inflammation. Why? Because inflammation now predicts cardiovascular events more accurately than cholesterol — especially in people already on statins or those without traditional risk factors. In some ways, cholesterol has become a victim of its own success. With routine screening and statins, most heart attack patients now have artificially lowered cholesterol. That leaves the remaining risk hidden in non-traditional biomarkers — beyond the usual SMuRFs (standard modifiable risk factors).
- Night_Thastus 1y agoIs this...a summary? The wording is so close to the article in parts that I'm not sure.
- brandonb 1y agoThis is a summary -- I'm the article author and the author of that comment, so I would hope my wording is consistent. :)
- Night_Thastus 1y agoOh, missed the username. Normally when people post a comment like that they prepend it with something like "Author here, just wanted to add X/Y/Z" I think there's supposed to be some kind of green highlight for comments by the poster but that's missing as well. Mea culpa.
- CleverLikeAnOx 1y agoGreen highlight is for new users.
- Night_Thastus 1y agoOh. They should add a highlight for comments written by the poster as well. Or some kind of [poster] tag, not sure. Would be useful in these cases.
- brandonb 1y agoFair point!
- pinkmuffinere 1y agoThanks for the summary! I haven’t read tfa yet, so my apologies if this is answered in there, but: does this mean that we’ve already reduced the contribution from cholesterol to events? Or that cholesterol was simply associated and not causative? I imagine the truth is somewhere in between, perhaps we can guess that’s it’s 70% due to one and 30% due to the other?
- brandonb 1y agoIt's more the former -- we've gotten so good at detecting high cholesterol and reducing it, that the majority of residual risk is now in the other factors. (There are some people who dispute whether cholesterol is causative, but most cardiologists believe LDL cholesterol, or ApoB, causes heart attacks and strokes --based on both mechanistic evidence and randomized control trials.)
- pigeonhole123 1y agoI'm interested in this subject. Can you cite some of the RCTs and mechanistic evidence?
- deleted 1y ago[deleted]
- pinkmuffinere 1y ago1. Thanks for the reply! 2. Having now read the article, i see that my question was indeed already addressed in the article — sorry for asking silly questions 3. Your good-natured, approachable response is great marketing for your company! I’m not the target audience, but I did click through your marketing material, and probably trust it more because of your response.
- SpicyUme 1y agoDoes this mean this test is recommenced in place of cholesterol for people who are not taking statins? Or is the test in addition?
- rodrig3 1y agoVery interesting recommendation - very much in line with this paper from a few weeks ago: https://pubmed.ncbi.nlm.nih.gov/40878356/ https://pubmed.ncbi.nlm.nih.gov/40878356/ TLDR: women who would otherwise be missed by current algorithms might be picked up by this inflammatory marker (hs-CRP)
- brandonb 1y agoI suspect Lp(a) is next, since there are now drugs in clinical trials that directly lower it.
- uniqueuid 1y agoIt’s important to put this in context. Lp(a) is a largely distinct risk factor from “ordinary” cholesterol and cannot be changed by diet or exercise. Survey papers show practically no effective treatment (statins help all cause mortality in patients but do not lower lp(a)). There are two (iirc) ongoing trials for new, effective drugs. But those are not available yet and will probably be prohibitively expensive, going by the advertisements that the companies run. So yeah, get an Lp(a) test once (it doesn’t vary too much over time) and reduce your other risk factors, but don’t put too much hope into an easy solution to this specific cause yet. edit: found the two papers that were a good read: Kamstrup, P. R. (2021). Lipoprotein(a) and Cardiovascular Disease. Clinical Chemistry, 67(1), 154–166. https://doi.org/10.1093/clinchem/hvaa247 https://doi.org/10.1093/clinchem/hvaa247 Schwartz, G. G., & Ballantyne, C. M. (2022). Existing and emerging strategies to lower Lipoprotein(a). Atherosclerosis, 349, 110–122. https://doi.org/10.1016/j.atherosclerosis.2022.04.020 https://doi.org/10.1016/j.atherosclerosis.2022.04.020
- scythe 1y ago> The ACC is now recommending that everyone measure inflammation (specifically, hs-CRP) Burying the lede a little, here. The ACC has decided on a standard way to measure inflammation, which decades ago was a centerpiece of some very woo-woo "following the squizledoff diet will decrease your gomperblorp"-style health 'advice'. "Systemic inflammation" was a very tricky physiological parameter to nail down.
- PantaloonFlames 1y agoOh yes I agree with you. This seems important.
- brandonb 1y agoDo you have a link to an article that covers the history? In the time that I've been following this topic (about 10 years), hs-CRP has been the go-to biomarker of inflammation. It'd be interesting to learn about the process required to get there.
- scythe 1y agoCRP and its subtypes have been known since 1930 as markers of acute inflammation such as following disease or injury. The measurement of chronic systemic inflammation is more difficult, because it involves lower levels of the biomarkers. So for example CRP levels increase by a factor of thousands when there is an infection, but in chronic systemic inflammation are elevated much more subtly. I don't know a great historical review but this "Nature Perspective" from 2019 seems pretty good: https://zellavie.ch/wp-content/uploads/2020/06/Nature-Medicine-2019.pdf https://zellavie.ch/wp-content/uploads/2020/06/Nature-Medici...
- jrjarrett 1y agoSo statins lower LDL; what lowers inflammation?
- PantaloonFlames 1y agoAvoid allergenic foods, Highly processed foods. Get plenty of sleep. Manage stress. Avoid toxins like alcohol or smoking. Avoid chemical irritants including perfumes, dyes, fragrances in detergent or soap, ….
- amatecha 1y agoNot sure why this is downvoted, this is correct on all points. I've been on a journey to lower chronic inflammation and you would not believe how hard it is to find stuff that doesn't have "fragrance" or other mysterious potentially-inflammation-causing substances. https://cancerblog.mayoclinic.org/2025/02/17/want-to-reduce-chronic-inflammation-start-with-your-grocery-list/ https://cancerblog.mayoclinic.org/2025/02/17/want-to-reduce-... https://health.clevelandclinic.org/anti-inflammatory-diet https://health.clevelandclinic.org/anti-inflammatory-diet https://health.clevelandclinic.org/foods-that-can-cause-inflammation https://health.clevelandclinic.org/foods-that-can-cause-infl... https://www.heartandstroke.ca/articles/the-anti-inflammatory-diet https://www.heartandstroke.ca/articles/the-anti-inflammatory... https://health.osu.edu/health/general-health/how-fragrances-affect-health https://health.osu.edu/health/general-health/how-fragrances-... https://pmc.ncbi.nlm.nih.gov/articles/PMC9163252/ https://pmc.ncbi.nlm.nih.gov/articles/PMC9163252/ https://www.amjmed.com/article/S0002-9343(25)00549-2/abstract https://www.amjmed.com/article/S0002-9343(25)00549-2/abstrac...
- maerF0x0 1y agofrom the heartandstroke.ca > Grains (mainly whole grains): 7-8 servings > 1 slice bread Who the heck is eating 7-8 slices of bread -- A DAY??? (or the equivalent)... Of a healthy bread that's about 900 calories just from breads... That's like 2 bowls of cereal for breakfast, 2 sandwiches for lunch, and 2 servings of pasta for dinner, whoa.
- breadwinner 1y agoCholesterol and statins have always been suspect science in any case: https://medium.com/@petilon/cholesterol-and-statins-e7d9d8eea983 https://medium.com/@petilon/cholesterol-and-statins-e7d9d8ee...
- bkandel 1y agoFrom https://www.cochrane.org/evidence/CD004816_statins-primary-prevention-cardiovascular-disease https://www.cochrane.org/evidence/CD004816_statins-primary-p...: > Of 1000 people treated with a statin for five years, 18 would avoid a major CVD event which compares well with other treatments used for preventing cardiovascular disease. Taking statins did not increase the risk of serious adverse effects such as cancer. Statins are likely to be cost-effective in primary prevention.
- guerby 1y agoPublished 2013
- malfist 1y agoThe human body evolves on a much slower time scale than decades
- guerby 1y agoPiles of money at stake, misinterpreting data, cherry picking data, misplaced pride leading to hiding data or worse, etc... What the BMJ has to say on this very topic of statins: https://www.bmj.com/campaign/statins-open-data https://www.bmj.com/campaign/statins-open-data So no settled science here. And remember that the largest ever study on saturated fat and cholesterol lowering was just not published by their original author because it didn't proove their hypothesis. https://pmc.ncbi.nlm.nih.gov/articles/PMC4836695/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4836695/
- malfist 1y ago
- softwaredoug 1y agoI have genetically high cholesterol. But otherwise I exercise quite a lot and healthy. I’ve been told not to worry about cholesterol unless other indicators start to climb. So I just generally avoid high saturated fat foods (sat fat in food matters more to blood cholesterol than food cholesterol).
- brandonb 1y agoHave you measured your Lp(a)? It's the strongest hereditary risk factor for heart disease. (Each Lp(a) particle is essentially a "normal" cholesterol particle with an extra protein that makes it 6x more atherogenic.)
- NoThisIsMe 1y ago> sat fat matter more to blood cholesterol than food cholesterol Can you expand on this? I don't understand.
- softwaredoug 1y agoEating excessive saturated fat is what your liver turns into too much "bad cholesterol" and what you need to watch if you're having cholesterol problems. Cholesterol in food doesn't usually translate to you having more cholesterol in your blood.
- themk 1y agoI would have to go dig up the source for this, but I believe that genetics play a role on how your body handles dietary cholestrol. For many it's not a problem, but for some it is.
- KempyKolibri 1y agoYeah, it's that and the relationship between dietary cholesterol and serum cholesterol isn't linear - once you're consuming a certain amount of dietary cholesterol, adding more doesn't make much difference to serum cholesterol. So for some individuals with a super clean, low cholesterol diet, adding dietary cholesterol would significantly impact their serum cholesterol. But for many (arguably most), it won't make much of a difference, which is one of the reasons DC has moved down in importance in dietary guidelines.
- baxtr 1y agoAnyone know how weight lifting might be related to this? Weight lifting causes short bursts of inflammation right after training, which is part of the repair process. But in general it is considered very beneficial.
- deleted 1y ago[deleted]
- hkt 1y agoI'd guess this is persistent, systemic inflammation. So I, as someone with IBD, have higher levels of CRP, so am probably a prime candidate for this kind of early death (despite having quite good cholesterol)
- diordiderot 1y agoI believe IBD only had a slight impact on all cause mortality figures.
- maerF0x0 1y agoI dont know the direct answer to your question, and am not a Doctor nor researcher... but using a generally applicable health pattern -- it's important not to equate acute anything with chronic anything. Eg: Acute fat loss via exercising while fasting does not seem to relate to body composition changes over 12 weeks. Similarly the self protective process of hormesis seems to actually create greater health - like reactions to heat from sauna usages for example.
- ashu1461 1y agoFundamentally weight lifting should reduce inflammation, but at the same time I’m less certain about how things like protein powders or very high protein intake factor into this.
- FollowingTheDao 1y agoWeightlifting increases inflammation acutely, not chronically. But if you work out too much without enough rest, then the inflammation is chronic and that’s where the danger is. Over the long-term resistance training decreases CRP level levels when adequate rest is involved.
- SoftTalker 1y agoDoes "inflammation" refer to a general systemic thing? Or does this refer to something specific such as tendonitis or inflammation due to injury?
- gwbas1c 1y agoUpvoted because I was going to ask the same thing: What is "inflammation" in this context?
- pizzathyme 1y agohs-CRP is the specific biomarker
- brandonb 1y agoChronic inflammation (a general systemic thing) is the thing we're mostly concerned about for heart health. The hs-CRP metric itself will pick up both acute inflammation (if you get sick) and chronic inflammation.
- FollowingTheDao 1y agoCRP is a protein produced by the liver in response to inflammation. Elevated CRP levels indicate inflammation in the bodY. High levels of CRP are associated with high levels of oxidative stress. https://pubmed.ncbi.nlm.nih.gov/15585208/ https://pubmed.ncbi.nlm.nih.gov/15585208/ Inflammation is a synonym for high levels of oxidative stress. Keep your oxidative stress low and you will not get heart disease.
- SketchySeaBeast 1y ago> Keep your oxidative stress low and you will not get heart disease. I think we should always be careful when we speak in absolutes. The conclusion from the article: > This result suggests that oxidative stress may be a determinant of [C-reactive protein] levels and promote pro-atherosclerotic inflammatory processes at the earliest stages of [coronary heart disease] development. I'm not saying the result is wrong, but I am saying "if you A you will not get B" is over-promising.
- sciencesama 1y agoHow do you measure inflammation !
- senthil_rajasek 1y agohs-CRP levels from a blood test.
- wyattchang11 1y agoSo does this mean apoB or hs-CRP is a better predictor of heart disease?
- sequoia 1y agoIs this an advertisement? There's a CTA for a $190 service above the fold.
- ed 1y agoIt is, but as siblings note the evidence is real. You can purchase the test directly from Labcorp for $59 – https://www.ondemand.labcorp.com/lab-tests/inflammation-hs-crp-test https://www.ondemand.labcorp.com/lab-tests/inflammation-hs-c...
- brandonb 1y agoNote that the $190 panel includes not just hs-CRP ($59), but also the other major heart health biomarkers: ApoB ($69), Lp(a) ($49), A1c ($39), lipid panel ($59), eGFR ($99), other biomarkers, and a video consultation with a doctor to actually explain the results and what to do about them.
- malfist 1y agoI'm wary of trusting new health science from a company trying to sell me the cure to what they just discovered was the _real cause_ of my ills. This article might be truthful, it might not. But it is absolutely trying to sell you something.
- johncolanduoni 1y agoIn fairness, the literature has been trending this way for a long time. Well before anyone had figured out a way to profit off of it.
- alphazard 1y agoYes, and the internet has helped quite a bit with this. Instead of a small group of people having access to research through university or hospital publishing networks, everything circulates on the internet for anyone to look at. My prediction is that this leads to many secular trends in diet and lifestyle. People have called keto a fad, but to me it looks like what happens when basic human endocrinology and how to manipulate it becomes widely known. I don't expect people to go back to high carb/low fat diets as a weight loss intervention, ever, even once the hype has worn off.
- rsanek 1y agoThe article is merely summarizing new recommendations from the American College of Cardiology. You can read the source if you prefer it: https://www.jacc.org/doi/10.1016/j.jacc.2025.08.047 https://www.jacc.org/doi/10.1016/j.jacc.2025.08.047
- adolph 1y agoThank you for linking. The first few paragraphs sound like this is kind of big deal, like print out and read.
- brandonb 1y agoI certainly get the skepticism. You might find the JACC article (which is an American College of Cardiology consensus statement) interesting, since the ACC is a neutral party here (and reviewed all the evidence around hs-CRP).
- mrjay42 1y agoSingle author Unknown editor No journal? Committee? Conference? Ew.
- p00dles 1y agohttps://www.jacc.org/doi/10.1016/j.jacc.2025.08.047 https://www.jacc.org/doi/10.1016/j.jacc.2025.08.047
- mrjay42 1y agoThanks!! I completely missed that.
- brandonb 1y agoThe post links to the JACC article (which is an American College of Cardiology consensus statement).
- mrjay42 1y agoYep yep, just saw that, thanks <3
- cryzinger 1y agoCurious about infliximab being unhelpful or even harmful for cardiovascular risk; I'm not sure if there were any confounding factors re. people on infliximab not generally being in great health to begin with. But back when I was on infliximab I had some not-awesome systemic side effects, so I wouldn't be chocked if it's just not great for your cardiovascular health in general. (And that's still probably a worthwhile tradeoff if you're the kind of person who's being prescribed infliximab.)
- hirvi74 1y agoIf you don't mind me asking, what was your like on Remicade (and/or what you swapped to)? I suppose I have the option of taking a biologic (not Remicade) for an immune mediated condition, but I can't help but shake the feeling that the cure might be worse than the disease in my particular situation.
- cryzinger 1y agoI don't mind at all! I started on Humira, switched to Remicade, now on Skyrizi. Remicade worked better than Humira for me, but it's a much stronger drug (and I worked my way up to a higher-than-default dose), so I was prone to some weird skin infections that I hadn't had on Humira despite both drugs acting on the same mechanism, and my immune system was weaker overall. Nothing serious, just annoying. And I wasn't actually responding that well to Remicade overall. But Skyrizi has been way more effective so far and had almost no side effects, knock on wood. I say "almost" because I've had some different, milder skin infections (mostly seborrheic dermatitis) that I can't say for certain were caused/exacerbated by Skyrizi, but either way it's miles better than active Crohn's disease so I'm not complaining! Obviously it depends on your particular condition and the drug in question, but my take is that unmediated immune dysfunction is worse for you 99% of the time than the side effects of any biologics used to treat it. (That calculus changes if we're talking about non-biologic options like methotrexate or steroids though, lol.) For example, when I was on TNF inhibitors, those come with a black box warning about how you might have a slightly higher risk of developing cancer while taking them... but that risk is still far lower than the inherent cancer risk from unchecked intestinal inflammation. Plus the fact that drug-induced cancer is (1) not a guarantee and (2) something you have a chance of beating, whereas choosing to suffer without effective IBD treatment would doom you to certain suffering and a very high likelihood of permanent bowel damage, etc. Different drugs just have very different impacts, too. Even though I took Remicade and Skyrizi to treat the same condition, the latter is an older drug with a shotgun-ish approach to immune suppression (even more so than Humira); Skyrizi is much newer and more like a sniper rifle. Newer isn't always better, but monoclonal antibodies in particular have come a long way even in the past decade or so, and I'm optimistic they're only gonna get better and better. I actually just read this the other day, which you might find interesting! https://worksinprogress.co/issue/how-to-make-an-antibody/ https://worksinprogress.co/issue/how-to-make-an-antibody/
- Aurornis 1y agoBefore you assume that LDL isn’t a good biomarker, read the entire article. Specifically this section: > Why? In some ways, cholesterol has become a victim of its own success. We now screen the whole population for high cholesterol, give statins to those with high LDL (or ApoB), and so then the majority of people who end up having heart attacks have lower cholesterol than they would naturally have In other words, in the study population patients who would have had high LDL were likely to be on statins. The had a lower measured LDL value even though they might still be consuming a poor diet and living an unhealthy lifestyle, for example. Statins don't fix everything about poor diet and lifestyle, but they do help with cholesterol. So don’t go throwing LDL out yet. It’s still the best measure we have, though you should obviously know that LDL measured while on statins is lower than it would be normally. The headline, therefore, is somewhat clickbait from a company trying to sell these tests to you outside of your insurance. I recommend checking your insurance to see if the tests would be covered before you go the self-pay route. Edit to add: If your doctor won't order hs-CRP for some reason, you can order it from sites like privatemdlabs.com for $50 (less if you take their 25% off coupon).
- FollowingTheDao 1y agoYes, LDL is the best we have since they won’t bother to measure oxidative stress nor inflammation in the human body. But lowering your LDL does not prevent heart disease. There are many many people with normal LDL who have heart attacks. In fact, it is the norm. And I can’t imagine how many people are being told. They have no heart disease risk just because their LDL is normal. It’s a crime and it needs to be stopped. https://www.uclahealth.org/news/release/most-heart-attack-patients-cholesterol-levels-did-not-indicate-cardiac-risk https://www.uclahealth.org/news/release/most-heart-attack-pa... A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, based on current national cholesterol guidelines.
- p1esk 1y agoHow can inflammation be measured?
- alphazard 1y agoThere is a theory that cholesterol elevates in response to circulating endotoxin (dead bacteria cell walls). Lipoproteins can bind to the endotoxin, and clear it or at least stop immune cells from reacting to it. This response increases LDL, but decreases the immune activity that would otherwise be created by letting the endotoxin circulate. So LDL is a defense mechanism against the body's own response to circulating endotoxin as well as the endotoxin itself. If true, that would explain the link between inflammation, LDL, and heart disease. It would also imply that the circulating endotoxin is the thing to target. I wonder where all the dead bacteria cell walls are coming from, probably where the dead bacteria are. That, of course, is the gut. I don't remember the original paper, but I found something that at least explains the theory here. https://www.sciencedirect.com/science/article/abs/pii/S0140673600026908 https://www.sciencedirect.com/science/article/abs/pii/S01406...
- sunshinerag 1y agoVery interesting
- chadcmulligan 1y agoSaw this the other day which may tie in with what you're saying? "Bacteria present in carotid arterial plaques are found as biofilm deposits which may contribute to enhanced risk of plaque rupture" : https://pubmed.ncbi.nlm.nih.gov/24917599/ https://pubmed.ncbi.nlm.nih.gov/24917599/
- alphazard 1y agoThat does seem related, but it suggests something even more unexpected, which is that live bacteria are forming biofilms in arterial plaque. So the LDL is picking up live and dead bacteria and then adhering to the side of arteries. Biofilms (for anyone unfamiliar) are a form of coordination used by bacteria. Through simple signaling mechanisms they are able to decide which bacteria are on the outer edge, and which bacteria are safe inside. The guys on the edge become hard and defensive, and protect the inner bacteria from threats (like the immune system).
- Citizen8396 1y ago
- nabla9 1y agoCholesterol can hide your inflammation. Cholesterol -> Coronary plaque -> Dormant bacteria within the plague biofilm is shielded from the immune system and antibiotics. When it ruptures, bacteria is released, sudden death. Viridans Streptococcal Biofilm Evades Immune Detection and Contributes to Inflammation and Rupture of Atherosclerotic Plaques https://www.ahajournals.org/doi/10.1161/JAHA.125.041521 https://www.ahajournals.org/doi/10.1161/JAHA.125.041521 >Of the bacteria detected, oral viridans group streptococcal DNA was the most common, being found in 42.1% of coronary plaques and 42.9% of endarterectomies.
- gavinray 1y ago28 years old, had a heart attack last weekend (inferior STEMi) I exercise an hour a day (resistance + cardio), eat a diet of nothing but meat + vegetables + yogurt. Will post my lipids below. Sometimes you just get fucked by life. https://i.imgur.com/r0nfUo3.png https://i.imgur.com/r0nfUo3.png For those that won't view the image: LDL: 72 HDL: 23 Triglycerides: 49 Apo(B): 85
- hirvi74 1y agoGlad you're still with us, mate. Was a hypothetical cause ever suggested?
- gavinray 1y agoI had vulnerable plaque rupture in an inferior artery that caused a 99% occlusion after thrombus formed over it Very genetically predisposed to cardiac events unfortunately
- KempyKolibri 1y agoGood luck to you, hope you keep on top of it. Do you know if you have high lp(a) out o curiosity? Curious what drives these events in cases such as yours.
- gavinray 1y agoI will soon, as a follow up from cardiologist. My money is on it being within normal limits. > Curious what drives these events in cases such as yours. In my case, I got dealt a very, very poor set of cardiac genes. Everyone on my mother's side has had at least one heart attack, though they generally started around age 50.
- gavinray 1y agoLp(a) = 22.2ng nmol/L
- 1y ago
- sethammons 1y agoInteresting that official recommendations are catching up to what some clinicians on the edge have been saying for years: inflammation may be a stronger predictor of heart disease than cholesterol. Clinician-authors like Dr. Gundry (who blame lectins/diet) have long argued inflammation is central, though their theories are more controversial and less trial-backed. The argument, as I recall, is that the inflammation causes your body to want to treat the inflamed area and when coupled with cholesterol causes "cholesterol Band-Aids" to be plastered all over your arteries. The argument is that if you remove the inflammation, the cholesterol is not important because it's not trying to be made into a Band-Aid.
- hombre_fatal 1y agoGundry is a huge quack. Listen to him on Dr Mike's podcast: https://www.youtube.com/shorts/LulcIT9XRFI https://www.youtube.com/shorts/LulcIT9XRFI -- Among many wtf claims, he claims that smoking is good for you because nicotine has antioxidants.
- KempyKolibri 1y agoI think that’s a disservice to quacks - most of them are far better at dressing up their claims in something believable sounding. Gundry is just stark raving mad, it blows my mind that anyone gives him the time of day.
- sethammons 1y agowow, that seems quite insane
- cinntaile 1y ago"Less trial-backed" is doing some heavy lifting here afaik, is there any reputable clinical evidence of this?
- _heimdall 1y agoThis isn't surprising, and its refreshing to see more research that questions the cholesterol hypothesis finally gaining some traction. You only have to read up on the history of how the cholesterol hypothesis came about to realize the science behind it was poorly defined, poorly tested, and arguably counterfeited as data was cherry picked.
- KempyKolibri 1y agoThis doesn't question the cholesterol hypothesis. The link between higher ApoB and increased risk of CVD and death is one of (if not the) best understood and well researched exposure/outcome relationships in human health research. We have converging evidence from in vitro studies, cohort studies, mendelian randomisation and randomised controlled trials all showing that lower ApoB/LDL results in reduced CVD and mortality. What would it take to convince you that the cholesterol hypothesis is more likely true than false, if not all the above?
- _heimdall 1y agoThis paper isn't directly challenging the cholesterol hypothesis but it is a step in that direction. If the data here is correct and inflammation is a better indicator of heart disease than cholesterol levels, it should raise questions whether cholesterol levels are correlative rather than causal.
- KempyKolibri 1y agoWhy would that raise questions about whether cholesterol levels are correlative rather than causal? Presumably one of “time spent working in asbestos factories” and “cigarette pack years” is more predictive of lung cancer incidence than the other. Does this being the case mean that either smoking or inhaling asbestos particles isn’t causally implicated in lung cancer? If the answer is “no”, then presumably you can see why the inference you’re making is faulty.
- _heimdall 1y ago
- ropable 1y agoI am extremely skeptical about the need for this kind of shotgun "health marker" blood panel test. Even granting the premise that whatever ML algorithm they use to interpret the results is at all accurate, the upshot is unlikely to change the general recommendations regarding heart disease anyway (control blood pressure, stop smoking, manage diabetes or pre-diabetes, maintain a healthy diet and meet the physical activity guidelines). If I'm being extra charitable, this kind of test might show up an elevated Lp(a) level, which is a risk factor. At which point you would want to consult a qualified physician, not rely on a single blood test interpreted by an algorithm.
- brandonb 1y agoFWIW, the linked article shows a specific biomarker that would change both medication and lifestyle, i.e., something you’d act on. The panel from the company above (I’m a co-founder) includes a review with an MD (not just an algorithm).
- ropable 1y agoThank you to the reply; the fact that there is a qualified human in the loop to review test results is very encouraging. I stand corrected on my initial assessment.
- patrickhogan1 1y agoIt’s important to note that hsCRP and C Reactive Protein are 2 different tests.
- elchief 1y agohttps://www.health.harvard.edu/staying-healthy/inflammation-a-unifying-theory-of-disease https://www.health.harvard.edu/staying-healthy/inflammation-...
- havkom 1y agoWhat about GLP-1 antagonists to lower inflammation / hs-CRP?
- tredeske 1y ago[dead]
- peteybeachsand 1y agois there something akin to a continuous glucose monitor but for inflammatory biomarkers? it would be so dope to be able to watch your body respond in real time to the foods you eat the way you can with a cgm
- Imanari 1y agoCame here to asks this. This could unlock a super powerful feedback loop towards fantastic health.
- brandonb 1y agoThe closest thing I've seen is the antioxidant index from Samsung's latest Galaxy Watch: https://www.mobihealthnews.com/news/samsung-debuts-galaxy-watch8-series-new-health-features https://www.mobihealthnews.com/news/samsung-debuts-galaxy-wa... It specifically measures carotenoids through the optical heart rate sensor -- you mostly get carotenoids from eating vegetables, and they do reduce inflammation.
- Lumoscore 1y agoThis is the study that finally confirms what a lot of people in the health/bio-hacking space have suspected for years! It’s not that cholesterol is irrelevant—it's still a primary risk factor—but it's clear it's only half the story. The headline makes sense because we've been treating the symptom (high cholesterol) so effectively with statins that for the remaining group of heart attack victims, the real driver is something else entirely: chronic inflammation. Essentially, high LDL provides the "gunk" for the plaque, but the plaque doesn't become dangerous until inflammation sets in and makes that plaque unstable enough to burst. If your arteries are calm, that cholesterol is less likely to kill you. The huge win here is the marker: hs-CRP (High-Sensitivity C-Reactive Protein). It's affordable, widely available, and now, officially a critical measure. If your LDL is fine but your hs-CRP is elevated, you have a massive, unaddressed "residual risk." I hope this pushes doctors to run that test routinely. For us, the message is clear: reducing systemic inflammation through diet, sleep, and stress management is now a non-negotiable part of heart health, even if your lipid panel looks great.
- dmodge 1y agoThis is now a thing because of the covid vax no less
- dmodge 1y agoThis is clearly now a thing due to the covid "vaccine" myocarditis, pericarditis
- tracker1 1y agoIt always did... even the way cholesterol recommendations have been aren't really good in and of themselves. The better marker is Triglyceride to HDL ratio, in terms of correlation to morbidity. Not total, not LDL by itself without quality tests.
- cthalupa 1y agoTrig/HDL and LDL/HDL ratios are outdated science that have been superseded by our better understanding of the causative factors and our ability to drive LDL way lower than we could in the past. MR studies have shown very little evidence higher HDL does much, if anything, to prevent CVD or serious adverse events. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60312-2/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... CETP inhibitors keep getting abandoned because they're not seeing improvement in cardiovascular outcomes, despite significant increases in HDL. One of the few that did show improvements in outcomes, anacetrapib, appears to have done it through a more significant reduction in LDL than the others, but even then, it was not promising enough for Merck to continue development, and it has since been abandoned. https://pmc.ncbi.nlm.nih.gov/articles/PMC5756107 https://pmc.ncbi.nlm.nih.gov/articles/PMC5756107 The current CETP inhibitors still in development such as obicetrapib are focused primarily on their ability to lower LDL rather than raise HDL. MVMR studies are also quite clear that absolute atherogenic particle count - primarily LDL-C/Lp(a) - are far more important than HDL #s. ApoB, which calculates the total of your atherogenic particles is probably the best marker we have. https://journals.plos.org/plosmedicine/article%3Fid%3D10.1371/journal.pmed.1003062 https://journals.plos.org/plosmedicine/article%3Fid%3D10.137... For a while we thought looking at sdLDL in particular might be a more specific signal to look at, since these are more atherogenic than larger LDL particles, but we've found they correlate so strongly in the vast majority of cases that it's really only something that matters as an exception rather than the rule
- tracker1 1y agoI get ApoB is a better marker... but it's been hard enough in my limited experience to even get the numbers for Tg and HDL from lab results from the doctors I've seen.... they tend to just go "number high, give drugs" Risk being higher when Tg is more than 2x HDL in adult men. Even then, I'm not sure that medication as intervention is always the right answer vs lifestyle changes, which are of course harder.
- spinoza1791 1y agoNo, you are all victims of a massive scheme to treat your poor habits with medications which wont create metabolic health. Stop eating all highly processed foods, like protein bars, restaurant foods cooked in seed oils and vegetables laced w pesticides. Eat pasture cattle, chicken, turkey, mozzarella, and organic fruit only. Cook in tallow or ghee only. Olive oils are fake. No more processed sugar. Learn to play pickleball, and make friends that bike, walk and are active. You will die from the normal American diet before retirement.Statins cause diabetes, GLP-1 50% reduction and Alzheimers per the CDC.