Talk:Lipid hypothesis

In 2019, the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) stated that clinical trials and human Mendelian randomization studies have demonstrated the role of LDL-C and LDL-CApoB-containing lipoproteins in atherosclerotic plaque formation and cardiovascular events. LDL-C is causally related to ASCVD. This is no longer a hypothesis but considered as fact:

Furthermore, these clinical trials have clearly indicated that the lower the achieved LDL-C values, the lower the risk of future cardiovascular (CV) events, with no lower limit for LDL-C values, or ‘J’-curve effect... Human Mendelian randomization studies have demonstrated the critical role of LDL-C, and other cholesterol-rich ApoB-containing lipoproteins, in atherosclerotic plaque formation and related subsequent CV events. Thus, there is no longer an ‘LDL-C hypothesis’, but established facts that increased LDL-C values are causally related to ASCVD, and that lowering LDL particles and other ApoB-containing lipoproteins as much as possible reduces CV events.

This is supported by another recent textbook overview

The first and most relevant update presented in the 2019 guidelines concerns the old concept of an “LDL-C hypothesis,” which is now replaced by the established causal role of elevated LDL-C levels in ASCVD. Besides this causal role, genetic studies have introduced the concept of exposure time, revealing that LDL-C also has a cumulative effect on the risk of ASCVD9, a longer-term exposure leads to a greater retention over time of LDL particles (or, more generally, proatherogenic apoB-containing particles) in the arterial wall. Thus, the overall effect of LDL-C level on ASCVD risk is determined by the combination of both plasma levels and time of exposure.

The article should be updated with the recent guidelines position. Psychologist Guy (talk) 15:23, 23 January 2024 (UTC)

The article title should change, too. There is also a category named "Lipid hypothesis" which would also need changes. What name would you suggest for both? CarlFromVienna (talk) 08:56, 29 January 2024 (UTC)

It might be too early days to change the title of the article right now, but lipid theory would probably be more accurate in the future. I know that many papers still refer to it as the "lipid hypothesis" but mainstream health organizations no longer really view it as just a hypothesis. Interestingly in the 1980s, the lipid hypothesis was referred to in books and papers as the "lipid theory of arteriosclerosis". I think lipid theory is correct but we should wait until more medical textbooks update the language. I think this will be happening in the next 2 years. Psychologist Guy (talk) 12:52, 12 February 2024 (UTC)

This section contained primary sources that fail WP:MEDRS . Aseem Malhotra is a noted conspiracy theorist, not a reliable source. Psychologist Guy (talk) 12:08, 10 May 2024 (UTC)

Malhotra is a noted cardiologist. There are indeed many conspiracy theorists around, but it is not valid scientifically to state that someone with whom disagrees is prima facie a conspiracy theorist. There have been many critiques of Keys's work over the decades, and the reader would be better off knowing the issues rather than hiding their existence. Surakmath (talk) 00:42, 20 August 2024 (UTC)

Have you read Aseem Malhotra's Wikipedia article? He promotes anti-vax nonsense. Let's not pretend he is a mainstream cardiologist, he is very much on the fringe. Psychologist Guy (talk) 01:01, 20 August 2024 (UTC)

@Psychologist Guy Why isn't other contrarian views aren't included such as "LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature (Ravsnkov et al)" https://pubmed.ncbi.nlm.nih.gov/30198808/ Pelinly (talk) 12:23, 21 October 2025 (UTC)

Ravsnkov writes books like this that run against all medical evidence and are of no relevance in the medical sciences. Mentioning him would be false balance. However he could be mentioned in a historic section that deals with fad diets and cultural curiosities. Blausonorisch (talk) 07:13, 22 October 2025 (UTC)

I haven't read his book, I am just of the opinion that the reader should be aware of the criticisms about Lipid Hypothesis as another user above has pointed out (some relevant researches: https://pastebin.com/Pujbztr7). Pelinly (talk) 17:59, 22 October 2025 (UTC)

Their criticisms of the lipid hypothesis are outdated and extremely WP:FRINGE. Cholesterol denialists like Ravsnkov and Aseem Malhotra (and even carnivore diet advocates like Ben Bikman) have even changed their view on LDL-c in the last few years (the paper you quoted is from 2018). They now accept that LDL is causal in atherosclerosis but only the small dense "fluffy" LDL particles like VLDL. They claim that the medium and large particles are entirely 'fine'. They have moved the goal posts considerably. They are wrong because all apoB lipoproteins are atherogenic. A Normal non-atherogenic LDL-C level is 20–40 mg/dl. If you have a high LDL you will be laying down plaque and that is exactly what with see with the majority of carnivore diet and low-carb advocates who promote this cholesterol denialist nonsense. Veg Historian (talk) 19:01, 22 October 2025 (UTC)