Summary by Utah Sports and Wellness

Link to Original Article:

  • American Journal of Medicine – September 2018
  • Robert DuBrof, MD
  • 22 References


The lipid hypothesis postulates that lowering serum cholesterol saves lives and prevents cardiovascular disease. Lowering low-density lipoprotein cholesterol has become the foundation of cardiovascular disease prevention guidelines, yet not all the evidence supports this recommendation.

Confirmation Bias and Conflict of Interest:

  • Clinicians often rely on the opinions of cholesterol experts for the management of their patients. Unfortunately, some experts selectively cite evidence that only validates their own opinion and disregard evidence to the contrary.
  • The 2014 AHA/ACC guideline on the management of acute coronary syndromes states, “Therapy with statins in patients reduces the rate of recurrent myocardial infarction, coronary heart disease mortality, need for myocardial revascularization, and stroke.”
  • Not mentioned in the above point was the Cochrane meta-analysis of statins for acute coronary syndrome, which reported no benefit in over 14,300 patients.
  • The National Lipid Association Statin Diabetes Safety Task Force concluded that the cardiovascular benefits of statin therapy outweigh the modest risk of developing diabetes.

Financial Conflicts of Interest:

  • In one survey, 71% of clinical policy committee chairs has financial conflicts.
  • In 2009, the Institute of Medicine issued recommendations intended to limit the influence of industry on physicians.
  • Proposals restrict physicians with financial conflicts from participating in guideline panels.
  • One can only speculate as to whether financial conflicts may have influenced current lipid recommendations.

These authors also note:

It is widely believed that foods low in cholesterol, but high in refined carbohydrates, are supposed to prevent coronary heart disease. However, there is newer evidence that these dietary changes have contributed to diabetes, which can then lead to coronary heart disease.

  • We should not ignore the benefits of a healthy lifestyle.
  • LDL-C is considered the primary constituent of atherosclerotic plaque.