Author(s)

David S. Schade¹, Lynda Shey², R. Philip Eaton¹

¹Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
²Diabetes Comprehensive Care Center, University of New Mexico Hospital, Albuquerque, NM, USA.

Both clinical and basic science studies during the last 30 years have emphasized the importance of cholesterol in the pathogenesis of atherosclerosis. There is a direct relationship between the level of circulating cholesterol (as LDLc remnant particles) and the incidence of cardiovascular events. However, this hypothesis has not gone unchallenged, both in social media and the scientific literature. This controversy has major consequences to the health of the public, because atherosclerosis is the number one cause of morbidity and mortality in the Western World. The proponents of the non-importance of atherosclerosis base their argument on certain studies. We have carefully examined these studies in order to address the validity of the challenges. Each of these studies has its own deficiencies as pointed out in this article. Overall, the evidence that cholesterol is not the primary underlying pathogenic factor causing heart attacks and strokes is based on a flawed interpretation of study results. These studies have several serious deficiencies including lost data, inadequate power, excessive drop outs, borderline significance, and lack of a control group. The conclusion that cholesterol is essential in the pathogenesis of atherosclerosis is critical for treating and preventing atherosclerosis and reducing the prevalence of cardiovascular disease.

Atherosclerosis, Cholesterol, LDL Cholesterol, Study Design, Statins, Cardiovascular Disease

Schade, D. , Shey, L. and Eaton, R. (2019) In Defense of the LDL Hypothesis. World Journal of Cardiovascular Diseases, 9, 245-252. doi: 10.4236/wjcd.2019.93022.