3 ms·

But if they have lower cholesterol and still have a heart attack, then certainly the causal link is not quite there. It seems you’re suggesting it’s a good prox

But if they have lower cholesterol and still have a heart attack, then certainly the causal link is not quite there. It seems you’re suggesting it’s a good proxy measurement if untampered by statins though

hombre_fatal 1y ago
Statins are generally administered after decades of exposure to high cholesterol/ApoB. Decades of plaque accumulation doesn't just go away when you lower your cholesterol. The question is if people who keep their cholesterol/ApoB low (e.g. Mendellian randomization) have better health outcomes, and the evidence is clear. Lifelong exposure to cholesterol/ApoB mediates atherosclerosis.
- PantaloonFlames 1y ago
  > Lifelong exposure to cholesterol/ApoB mediates atherosclerosis I would normally interpret that to mean, lifelong elevated levels of cholesterol/ApoB _decreases_ atherosclerosis. Is that what you meant?
  - deleted 1y ago
    [deleted]
  - mikeyouse 1y ago
    In medicine, “mediates” is mostly synonymous with “facilitates”. So ‘lifelong exposure to cholesterol facilitates atherosclerosis’ - mediates is a bit softer since health changes often involve multiple pathways and can be impacted by many other processes.
lazyasciiart 1y ago
I personally have naturally very low cholesterol and also had a heart attack in my 30s. There are a handful of case studies published of other people in this scenario but it is a rare enough scenario, and it is vanishingly rare to have years of reliable cholesterol results without known high risk.
KempyKolibri 1y ago
I'm not sure I follow - is this what you're saying: P1: exposure X is not causally linked to outcome Y if some individuals with lower exposure to X have outcome Y. P2: some individuals with lower exposure to serum cholesterol have heart attacks. C: serum cholesterol is not causally linked to heart attacks. Because this has some wacky implications: P1: exposure X is not causally linked to outcome Y if some individuals with lower exposure to X have outcome Y. P2: some individuals with lower exposure to cigarettes have lung cancer. C: smoking is not causally linked to lung cancer.
- spacebanana7 1y ago
  Correlation is informative, but neither necessary nor sufficient for causation. For example, smokers likely purchase more lighters than non-smokers so there should be some correlation between lighter purchase frequency and lung cancer. But we all know you can't get lung cancer merely from buying lighters.
  - KempyKolibri 1y ago
    We could grant all that for the sake of argument but it wouldn’t interact with anything I said. I’m talking specifically about the claim that because individuals with a low exposure to something don’t necessarily have a given outcome, there is no causal pathway between the exposure and the outcome. It’s not clear to me how what you’ve written speaks to anything regarding that claim. Not trying to be snarky, I just want to be really clear about the point I’m trying to make here.
    - spacebanana7 1y ago
      Ah I see what you mean. Thanks for clarifying
      - KempyKolibri 1y ago
        Welcome! Thanks for being understanding.

hombre_fatal 1y ago

Statins are generally administered after decades of exposure to high cholesterol/ApoB. Decades of plaque accumulation doesn't just go away when you lower your cholesterol. The question is if people who keep their cholesterol/ApoB low (e.g. Mendellian randomization) have better health outcomes, and the evidence is clear. Lifelong exposure to cholesterol/ApoB mediates atherosclerosis.

PantaloonFlames 1y ago
> Lifelong exposure to cholesterol/ApoB mediates atherosclerosis I would normally interpret that to mean, lifelong elevated levels of cholesterol/ApoB _decreases_ atherosclerosis. Is that what you meant?
- deleted 1y ago
  [deleted]
- mikeyouse 1y ago
  In medicine, “mediates” is mostly synonymous with “facilitates”. So ‘lifelong exposure to cholesterol facilitates atherosclerosis’ - mediates is a bit softer since health changes often involve multiple pathways and can be impacted by many other processes.

lazyasciiart 1y ago

I personally have naturally very low cholesterol and also had a heart attack in my 30s. There are a handful of case studies published of other people in this scenario but it is a rare enough scenario, and it is vanishingly rare to have years of reliable cholesterol results without known high risk.

KempyKolibri 1y ago

I'm not sure I follow - is this what you're saying: P1: exposure X is not causally linked to outcome Y if some individuals with lower exposure to X have outcome Y. P2: some individuals with lower exposure to serum cholesterol have heart attacks. C: serum cholesterol is not causally linked to heart attacks. Because this has some wacky implications: P1: exposure X is not causally linked to outcome Y if some individuals with lower exposure to X have outcome Y. P2: some individuals with lower exposure to cigarettes have lung cancer. C: smoking is not causally linked to lung cancer.

spacebanana7 1y ago
Correlation is informative, but neither necessary nor sufficient for causation. For example, smokers likely purchase more lighters than non-smokers so there should be some correlation between lighter purchase frequency and lung cancer. But we all know you can't get lung cancer merely from buying lighters.
- KempyKolibri 1y ago
  We could grant all that for the sake of argument but it wouldn’t interact with anything I said. I’m talking specifically about the claim that because individuals with a low exposure to something don’t necessarily have a given outcome, there is no causal pathway between the exposure and the outcome. It’s not clear to me how what you’ve written speaks to anything regarding that claim. Not trying to be snarky, I just want to be really clear about the point I’m trying to make here.
  - spacebanana7 1y ago
    Ah I see what you mean. Thanks for clarifying
    - KempyKolibri 1y ago
      Welcome! Thanks for being understanding.