Hacker News

Low cholesterol targets cut cardiovascular events by 33%(empirical.health)

20 points by brandonb 1 day ago | 17 comments

The 55 mg/dL target in this study is somewhere between the 1st and 5th percentile.

70 mg/dL (the control) is around the 10th percentile.

IMO, surprising that reductions at the low end still seem to yield such large benefits. I'd expect it to saturate much earlier.

[–] moeffju 10 hours ago

Maybe one caveat: his wasn't a trial of healthy people trying to optimize their cholesterol. It was secondary prevention, i.e. people with previous cardiovascular events. Looks like a solid study though.

[–] brandonb 4 hours ago

Very fair caveat!

[–] kashunstva 1 day ago

> The <55 mg/dL group had a 33% lower rate of cardiovascular events. That’s surprising large, particularly for a 43-year study.

A 43-year study?! That would put the enrolment date starting in 1983, four years before the first clinically available statin.

The referenced study looked at cardiovascular endpoints at 3 years, not 43 years.

[–] brandonb 19 hours ago

Typo—thanks for pointing it out, I fixed the post.

[–] erelong 1 day ago

I think there's been a pushback on this view lately, that this is only one factor to consider or that the studies leading to this kind of conclusion are flawed?

[–] brandonb 18 hours ago

Yep, LDL cholesterol is one of six biomarkers:

* ApoB or LDL cholesterol

* Blood pressure

* Inflammation (hs-CRP)

* Lipoprotein(a) (strongest hereditary risk factor)

* HbA1c (metabolic health)

* eGFR (kidneys)

Modern cardiovascular risk calculators like PREVENT take all of biomarkers factors and give you a 30-year forecast of your risk of heart disease.

[–] jvanderbot 1 day ago

Outlive is an excellent book, and one of the excellent discussions in that book is that there is no safe level of certain kinds of cholesterol. The details are fun do read up on.

It's somewhat bombastic, but a really excellent book for overall "next generation" health.

[–] yfw 1 day ago

He also recommends people take rapamycin for longevity...

[–] esperent 1 day ago

It's a while since I read the book but what I remember is him saying that he personally chooses to use it but the evidence is not strong enough to give a definite recommendation so basically, make your own choice.

[–] DANmode 10 hours ago

In the context of new models showing cell identity drift being a threat to longevity (vs simple cell breakdown over time), controlling “low-level” and chronic infection makes more and more sense.

[–] jvanderbot 20 hours ago

The book is overall excellent and extremely data driven. I have no idea why a book recommendation, on topic, can get downvoted on HN nowadays.

[–] esperent 1 hour ago

Because outside of a few narrow technical spheres the HN hivemind isn't data driven, it's cynicism driven.

[–] DANmode 1 day ago

Perhaps cholesterol is a (protective?) substance associated with a problem,

not the problem in and of itself.

[–] westurner 1 day ago

Do steak and pork from Cheesecake Factory have cholesterol?

[–] westurner 1 day ago

ScholarlyArticle: "Intensive LDL Cholesterol Targeting in Atherosclerotic Cardiovascular Disease" (2026) https://www.nejm.org/doi/full/10.1056/NEJMoa2600283

[–] westurner 1 day ago

Do they control for arterial calcification?

Mentioning this again: Cyclodextrin apparently effectively treats atherosclerosis and arteriosclerosis. [1][2]

[1] "AI analysis of CT scans finds 42.9% of patients have coronary inflammation" https://news.ycombinator.com/item?id=50202532 :

> Can Beta-Cyclodextrin treat (calcified) atherosclerotic plaques? And gout?

> What percentage of cardiovascular "plaque" is sugar alcohol and thus apparently treatable with β or α cyclodextrin, in controls and patients with conditions like Arteriosclerosis and Atherosclerosis?

[2] "Cyclodextrin promotes atherosclerosis regression via macrophage reprogramming" (2016) https://www.science.org/doi/10.1126/scitranslmed.aad6100