Item — HN Reader

For decades, LDL cholesterol has been the main target in preventive heart health.

The American College of Cardiology just started recommending that everyone measure hs-CRP, a blood test for inflammation. Why? Because inflammation now predicts cardiovascular events more accurately than cholesterol — especially in people already on statins or those without traditional risk factors.

In some ways, cholesterol has become a victim of its own success. With routine screening and statins, most heart attack patients now have artificially lowered cholesterol. That leaves the remaining risk hidden in non-traditional biomarkers — beyond the usual SMuRFs (standard modifiable risk factors).

3 comments

Thanks for the summary! I haven’t read tfa yet, so my apologies if this is answered in there, but: does this mean that we’ve already reduced the contribution from cholesterol to events? Or that cholesterol was simply associated and not causative? I imagine the truth is somewhere in between, perhaps we can guess that’s it’s 70% due to one and 30% due to the other?

It's more the former -- we've gotten so good at detecting high cholesterol and reducing it, that the majority of residual risk is now in the other factors.

(There are some people who dispute whether cholesterol is causative, but most cardiologists believe LDL cholesterol, or ApoB, causes heart attacks and strokes --based on both mechanistic evidence and randomized control trials.)

1. Thanks for the reply!

2. Having now read the article, i see that my question was indeed already addressed in the article — sorry for asking silly questions

3. Your good-natured, approachable response is great marketing for your company! I’m not the target audience, but I did click through your marketing material, and probably trust it more because of your response.

I'm interested in this subject. Can you cite some of the RCTs and mechanistic evidence?

Does this mean this test is recommenced in place of cholesterol for people who are not taking statins? Or is the test in addition?

Recommended in addition to cholesterol (or better yet, ApoB). And recommended for everyone, not just those taking statins.

Interesting, thanks. I'm changing docs/insurance and thinking about the tests I should be paying attention to.

Is this...a summary? The wording is so close to the article in parts that I'm not sure.

This is a summary -- I'm the article author and the author of that comment, so I would hope my wording is consistent. :)

Oh, missed the username. Normally when people post a comment like that they prepend it with something like "Author here, just wanted to add X/Y/Z"

I think there's supposed to be some kind of green highlight for comments by the poster but that's missing as well.

Mea culpa.

Green highlight is for new users.

Oh. They should add a highlight for comments written by the poster as well. Or some kind of [poster] tag, not sure. Would be useful in these cases.

Fair point!