Excellent write-up. We need those who have very high cholesterol to up the fiber in their diet. And eat fish weekly. In the U.S. some supplements are not pure.

Expand full comment

Thoughts RE: neg coronary artery calcium scan in face of skewed lipid profile?

Expand full comment

I was surprised that there was no mention here of the value (or not) of reducing one's consumption of saturated fat. For those with high LDL numbers and whose regular diet includes high amounts of saturated fat, is that not a sensible thing to try?

Expand full comment

Looking forward to the article on diet and potential to reduce cholesterol. Cant really find clear advice on this. Reduce saturated fat, yes, but no specific guidance, and lots of stuff about eating almonds etc. Hoping you can give the definitive summary.

Expand full comment

I'm not convinced that LDL is a cause of CAD or not, but I'm also not convinced that low LDL and taking statins is bad for me. Thus, I take my meds and my lipid numbers are stellar.

Expand full comment

I was expecting Plant Sterols like Benecol to be included in the article. Do you think they work?

My LDL for the first time is raised 2.95 mmol/L, Triglyceride 0.68 mmol/L,

HDL 2.76 mmol/L , Non-HDL 3.26


T.Chol/HDL Ratio 2.18

I have started taking Benecol - I did not know about the other options you mention here.

In your opinion are they a better choice than Benecol?

Thank you .

Expand full comment

What if you have high LDL and no evidence of arterial plaques?

Expand full comment

You say "The evidence that high LDL cholesterol CAUSES coronary artery disease is overwhelmingly clear"

I thought the number of lipoproteins was the cause (apob), not their content. Or is it beign too nit-picky ?

Expand full comment

Very helpful piece.

I’ve been influenced by this:


They found ‘a surprisingly weak and inconsistent relationship between the degree of reduction in LDL cholesterol from taking statins and a person’s chance of having a heart attack or stroke’.

The effect of taking statins: ‘absolute risk reduction of dying, having a heart attack or stroke was 0.8%, 1.3% and 0.4% respectively.’

What’s your take on that?

Expand full comment

Have you seen anything on combining a statin with Berberine? Sort of a poor man’s pcsk9 inhibitor?

Expand full comment