Cholesterol denialism

Cholesterol denialism is a form of pseudoscientific denialism that asserts that high blood LDL cholesterol levels do not increase the risk of cardiovascular disease.Cholesterol Denialism is Pseudoscience. medscape.com. A related idea known as statin denialism holds that statin usage does not reduce the likelihood of cardiovascular disease. Proponents claim that statins should be avoided because they are sold by Big Pharma and cause adverse side effects. It is promoted by carnivore diet and LCHF conspiracy theorists and has a presence on social media platforms such as Twitter.
Cholesterol and statin deniers claim that saturated fat has wrongly been demonized by medical scientists and is healthy for dieting in very high quantities. They say that there is no link between LDL-C and total blood cholesterol levels and the risk of cardiovascular disease.Butter nonsense: the rise of the cholesterol deniers This view is contradicted by scientific evidence and has been described as bad science and dangerous.
The leading advocates of cholesterol and statin denialism are associated with The International Network of Cholesterol Skeptics (THINCS). They have been accused of "cherry-pick[ing] the scientific literature to find studies that support their theses, ignore the flaws in those studies, and ignore the vast body of literature that contradicts them."Statin Denialism Statin denialists are known to exaggerate the side effects of statins and utilize scaremongering tactics.The Movie “Cholesterol: The Great Bluff” Is an Exercise in Denialism
Global deaths attributable to high LDL-C increased from 3 million in 1990 to 4.4 million in 2019.Global Burden Attributable to High Low-Density Lipoprotein-Cholesterol From 1990 to 2019 (DALYs) attributable to high LDL-C also increased from 69.7 million in 1990 to 98.6 million in 2019. In 2021, the World Heart Federation reported that elevated LDL-C contributed to 3.8 million CVD deaths.https://world-heart-federation.org/wp-content/uploads/World-Heart-Report-2023.pdf
==Criticism from the medical community==
Cholesterol and statin denialism is not taken seriously by the medical community. Poor adherence to statin therapy is linked to significantly increased risk of cardiovascular events and death.Lansberg et al 2018. Nonadherence to statins: individualized intervention strategies outside the pill box. Vasc Health Risk Manag 14: 91–102.
In 2017, cholesterol denialist Aseem Malhotra and colleagues published an article which disputed the link between blood cholesterol levels and occurrence of heart disease. The authors also suggested that "stopping statins may paradoxically save more lives".Demasi, M; Lustig R. H; Malhotra A. (2017). "The cholesterol and calorie hypotheses are both dead — it is time to focus on the real culprit: insulin resistance". The Pharmaceutical Journal doi:10.1211/CP.2017.20203046. The article was criticized by the medical community. Cardiologist Tim Chico commented that "high cholesterol has been proven beyond all doubt to contribute to coronary artery disease and heart attack […] to say the cholesterol hypothesis is dead is simply incorrect."Expert reaction to new report on statins and the cholesterol hypothesis
Cardiologist Steven E. Nissen, has described statin denialism as an "internet-driven cult with deadly consequences."Nissen SE. (2017). "Statin Denial: An Internet-Driven Cult With Deadly Consequences". Ann Intern Med. 2017 Aug 15;167(4): 281-282. He has also written that "we have abundant scientific evidence demonstrating that treatment of high risk primary prevention patients substantially reduces the risk of cardiovascular morbidity." Whilst acknowledging that statins, like other drugs, have adverse effects, "the benefits are so well documented that every effort should be made to encourage use of these drugs in appropriate patients."Nissen Calls Statin Denialism A Deadly Internet-Driven Cult
Professor of Medicine and Epidemiology Rory Collins has compared statin denialism to flat earthism, he has noted "the claims that blood LDL cholesterol levels are not causally related to cardiovascular disease (which is really in the same realm as claiming that smoking does not cause cancer) are factually false."
James Stein, a Professor of Cardiovascular Research has stated that "many lives have been lost or impaired because of statin non-compliance."Dr. James Stein Speaks Out Against "Statin Denialism"
In 2019, a joint editorial was published in the top cardiovascular journals around the world to warn people about the medical misinformation of statin denialism found on social media.Editors-in-chief of major cardiovascular journals claim medical misinformation puts “lives at stake”.Hill JA, et al. Medical misinformation: vet the message!. European Heart Journal - Cardiovascular Pharmacotherapy 5 (2): 62-63.Medical Misinformation: Vet the Message!. List of the journals that have published the editorial.
== "But they're measuring the wrong things!" ==
Blood levels of LDL cholesterol (the "bad" cholesterol correlated with heart disease) are typically calculated by measuring total blood cholesterol (in mg/dL in the U.S. and mmol/L elsewhere), subtracting the measured amount of HDL cholesterol, and further subtracting a constant fraction of the measured blood triglycerides.LDL-Cholesterol – The “Bad” Cholesterol Explained, Sigurdsson, Doc's Opinion, 24-Mar-2019
While this is good enough for most people, cholesterol denialists aren't most people. They'll claim that it's the ratio of LDL cholesterol to HDL cholesterol, not the absolute amounts, that matter, and therefore cholesterol doesn't cause heart disease. They'll claim that the triglyceride-to-cholesterol ratio isn't always constant, which screws up the calculation for LDL cholesterol levels, therefore cholesterol doesn't cause heart disease. They'll claim that it's the LDL particle count (LDL-P), not the LDL cholesterol level (LDL-C) that matters, therefore cholesterol doesn't cause heart disease.The Diet-Heart Myth: Why Everyone Should Know Their LDL Particle Number, Chris Kresser, 17-March-2019 They'll claim that there are two kinds of LDL cholesterol molecules -- large and fluffy, versus small and dense -- and that therefore cholesterol doesn't cause heart disease. I think you can see the pattern here.
==LDL-C and ApoB==
There is a strong medical consensus from clinical trials and human Mendelian randomization studies that LDL-C is causally related to atherosclerotic cardiovascular disease, and that lowering LDL particles and other ApoB-containing lipoproteins as much as possible reduces cardiovascular events.Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a Mendelian randomization analysis. pubmed.ncbi.nlm.nih.gov.2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). academic.oup.com.
By 2012, many clinical trials had been done.The Lipid Hypothesis The Cholesterol Treatment Trialists' Collaboration confirmed the LDL-C hypothesis after examining data from 26 trials involving 170 000 participants. According to their meta-analysis:
In 2019, the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) stated that the "LDL-C hypothesis" is no longer a hypothesis, it is an established fact:
The above is supported by current textbooks on lipidology. For example, Clinical Lipidology: A Companion to Braunwald's Heart Disease (third edition), published in 2024 states:
LDL particle concentrations drive the majority of atherogenic lipoprotein risk because they represent the majority of all circulating apoB particles. The consensus is to keep ApoB-containing lipoproteins low to reduce atherosclerotic cardiovascular disease risk. 
Cholesterol denialists are either unaware about any of these scientific developments or ignore all of the modern research from clinical trials and human Mendelian randomization studies.
==Lipoprotein (a)==
It is widely accepted in the scientific community that elevated Lipoprotein (a) is an independent risk factor for atherosclerotic cardiovascular disease and stroke.An Update on Lipoprotein(a): The Latest on Testing, Treatment, and Guideline Recommendations. acc.org.Lipoprotein (a) and risk of cardiovascular disease--a systematic review and meta analysis of prospective studies. pubmed.ncbi.nlm.nih.gov.Lipoprotein (a) and Stroke: A Meta-Analysis of Observational Studies. ahajournals.org.Lipoprotein(a) and Risk of Ischemic Stroke in the REGARDS Study. ahajournals.org.Elevated Lipoprotein(a) and Risk of Ischemic Stroke. jacc.org.Lipoprotein(a) as a Risk Factor for Cardiovascular Diseases: Pathophysiology and Treatment Perspectives. ncbi.nlm.nih.gov.Lipoprotein(a) and its Significance in Cardiovascular Disease: A Review. jamanetwork.com. LP(a) can increase the risk of developing cardiovascular disease even when LDL-C levels are within the recommended range. Lp(a) levels are to a large extent genetically determined with little influence from environmental or lifestyle factors.Lipoprotein (a), an independent cardiovascular risk marker. ncbi.nlm.nih.gov.Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. ahajournals.org.Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. lipidjournal.com. Typically they do not change after 5 years of age except during times of significant inflammation, liver disease or kidney disease.Lipoprotein(a) in Clinical Practice. acc.org. It is recommended that LP(a) should be measured in everyone at least once in a lifetime.Eight reasons why lipoprotein(a) should be measured in everyone at least once in a lifetime. academic.oup.com.
In 2022, the European Atherosclerosis Society stated:
Recently, cholesterol denialists who deny that LDL-C increases cardiovascular disease risk now accept that Lipoprotein (a) increases risk.For example, Paul Saladino https://www.youtube.com/watch?v=AYFb9o6kdmQ This view from cholesterol denialists is contradictory as noted by Alan Flanagan:
Currently there are no approved drug treatments to lower Lp(a). Clinical trials are currently being conducted on Lepodisiran and Muvalaplin.Trial Shows a Single Dose of an Experimental Therapy Reduces Lipoprotein(a), an Important Heart Disease Risk Factor, More than 94% for Nearly a Year. newsroom.clevelandclinic.org.First oral treatment for Lipoprotein(a) shows significant cholesterol reduction. news-medical.net.
==Serum cholesterol==
Serum cholesterol also known as total blood cholesterol refers to the total amount of cholesterol in the blood.Understand your cholesterol test results. heartuk.org.uk It is calculated by summing the HDL level, LDL level, and 20% of the triglyceride level present in a blood sample.What Your Cholesterol Levels Mean. heart.org.How to calculate total cholesterol. medicalnewstoday.com.What is serum cholesterol?. medicalnewstoday.com. There is a broad consensus that serum cholesterol should be under 200 mg/dl.Lipid Panel. hopkinsmedicine.org.Patient education: High cholesterol and lipids (Beyond the Basics). uptodate.com.Cholesterol Levels. medlineplus.gov. There is over 40 years of consistent epidemiological research showing that high serum cholesterol is associated with an increased cardiovascular disease risk in both young and older persons.Serum Cholesterol Levels and Risk of Cardiovascular Death: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies. pubmed.ncbi.nlm.nih.gov.Clarifying the direct relation between total cholesterol levels and death from coronary heart disease in older persons. pubmed.ncbi.nlm.nih.gov.Effect of Change in Total Cholesterol Levels on Cardiovascular Disease Among Young Adults. pubmed.ncbi.nlm.nih.govLifetime risk of coronary heart disease by cholesterol levels at selected ages. pubmed.ncbi.nlm.nih.gov.Lipids and risk of coronary heart disease. The Framingham Study. pubmed.ncbi.nlm.nih.gov.A Combination of Blood Pressure and Total Cholesterol Increases the Lifetime Risk of Coronary Heart Disease Mortality: EPOCH-JAPAN. pubmed.ncbi.nlm.nih.gov.Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease. pubmed.ncbi.nlm.nih.gov.Beyond low-density lipoprotein cholesterol: respective contributions of non-high-density lipoprotein cholesterol levels, triglycerides, and the total cholesterol/high-density lipoprotein cholesterol ratio to coronary heart disease risk in apparently healthy men and women. pubmed.ncbi.nlm.nih.gov.Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study. pubmed.ncbi.nlm.nih.gov.Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis. pubmed.ncbi.nlm.nih.gov. Recent research supports the lipid hypothesis that lower serum cholesterol is associated with reduced coronary heart disease risk.Serum Cholesterol and Impact of Age on Coronary Heart Disease Death in More Than 4 Million Veterans. ahajournals.org.
==List of notable cholesterol denialists==
==See also==
*Saturated fat and cardiovascular disease
*Dietary cholesterol
*Institute for Natural Healing
*Vaccine denialism
==References==
 
Category:Denialism