Does LDL cause ASCVD? Part 2 – Diet and Health Today

Executive summary

* This is the second of a two-part note reviewing the classic Ference et al “consensus statement on LDL and ASCVD“, which was published in 2017.

* The publication claimed that low density lipoproteins (LDL) (one of the five major carriers of lipids) cause atherosclerotic cardiovascular disease (ASCVD).

* This second note briefly mentions three published critiques of the Ference et al paper.

* My critique uses the best evidence presented by Ference et al (randomised controlled trial data) to review their much cited image (Figure 2). Figure 2 showed the relationship between the reduction in LDL-Cholesterol (LDL-C) and the reduction in risk of coronary heart disease (CHD). That was supposed to make the claim that LDL causes ASCVD. Part 2, even more than Part 1, shows how ‘fast and loose’ Ference et al were with definitions.

* My main challenge to the Ference et al claim (alongside last week’s mechanism scepticism) is that the strength of the relationship in Figure 2 is so low as to make causation unlikely.

* That challenge used Ference et al’s data for the reduction in LDL-Cholesterol. I then used the Cholesterol Treatment Trialist’s data to undermine even the claimed association between levels of LDL-Cholesterol and vascular events.

* Finally, I reviewed what UK and US public health bodies use to predict risk of ASCVD. Guess what’s not used?

At the end of this note, there’s a summary of why I don’t think the case has been made that LDL causes ASCVD.