Industry Figure Tom Chappell

There’s a good article by Gary Taubes (author of Good Calories, Bad Calories) in today’s New York Times (run, I was amused to see, as an Op-Ed), discussing the belatedly-published Vytorin trial results, which touches on one of the issues that he raises in his book, but about which I’ve been too lazy to blog about, as yet — the distinction between low-density lipoproteins (LDL), and the cholesterol carried inside of them.

Though there has been reason to think, for 50 years now, that problems with the LDL lipoproteins themselves were a more important risk factor than the cholesterol they carried, measuring the former wasn’t diagnostically practicable, because of the difficulty and cost, whereas measuring the latter was easy and cheap. In the battle against heart disease, an army of researchers went to war, not with the tools that they might have wanted to have, but with the tools that they had.

In 1977, the researchers reported their results: total cholesterol turned out to be surprisingly useless as a predictor. Researchers involved with the Framingham Heart Study found that in men and women 50 and older, “total cholesterol per se is not a risk factor for coronary heart disease at all.”

The cholesterol in low-density lipoproteins was deemed a “marginal risk factor” for heart disease. Cholesterol in high-density lipoproteins was easily the best determinant of risk, but with the correlation reversed: the higher the amount, the lower the risk of heart disease.

These findings led directly to the notion that low-density lipoproteins carry “bad” cholesterol and high-density lipoproteins carry “good” cholesterol. And then the precise terminology was jettisoned in favor of the common shorthand. The lipoproteins LDL and HDL became “good cholesterol” and “bad cholesterol,” and the lipoprotein transport vehicle was now conflated with its cholesterol cargo. Lost in translation was the evidence that the causal agent in heart disease might be abnormalities in the lipoproteins themselves.

The truth is, we’ve always had reason to question the idea that cholesterol is an agent of disease. Indeed, what the Framingham researchers meant in 1977 when they described LDL cholesterol as a “marginal risk factor” is that a large proportion of people who suffer heart attacks have relatively low LDL cholesterol.

The article is well-written, dense with information, difficult to synopsize (or at least, I’ve found it so), and is, as I’ve already mentioned, short, and worth reading in its entirety.

Read the Full Article in the New York Times
“What’s Cholesterol Got to Do With It?”
by Gary Taubes