Dr. Ronald Krauss on LDL Cholesterol, Particle Size, Heart Disease & Atherogenic Dyslipidemia

0:31:20 Ronald Kraussneeds contextmoderate

The effect of dietary cholesterol on blood cholesterol levels and cardiovascular disease risk in the general population is very small to almost unmeasurable.

"And when I went through the literature, I was just astonished at how small the effect is, and it's very difficult to even imagine how an effect of excess dietary cholesterol could influence heart disease risk, unless one just either had a mutation that caused the cholesterol to build up or one was eating an enormous amount of dietary cholesterol. But for the most part, the effect was so small that it was almost unmeasurable." (said at 0:31:20)

Systematic reviews, meta-analyses, and the American Heart Association (AHA) Science Advisory confirm that the relationship between dietary cholesterol and cardiovascular disease (CVD) risk is generally weak or non-significant in general population observational cohorts. However, characterizing the effect on circulating cholesterol as 'almost unmeasurable' is an exaggeration: randomized feeding trials reliably show a modest, statistically significant dose-dependent increase in serum total and LDL cholesterol (approximately 1.9 to 4.6 mg/dL per 100 mg/day of dietary cholesterol, or an average net increase of ~6.7 mg/dL LDL).

context: Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. (The American journal of clinical nutrition 2015) · cited 363x in the literature
"Dietary cholesterol was not statistically significantly associated with any coronary artery disease (4 cohorts; no summary RR), ischemic stroke (4 cohorts; summary RR: 1.13; 95% CI: 0.99, 1.28), or hemorrhagic stroke (3 cohorts; summary RR: 1.09; 95% CI: 0.79, 1.50). Dietary cholesterol statistically significantly increased both serum total cholesterol (17 trials; net change: 11.2 mg/dL; 95% CI: 6.4, 15.9) and low-density lipoprotein (LDL) cholesterol (14 trials; net change: 6.7 mg/dL; 95% CI: 1.7, 11.7 mg/dL)." (abstract, results, passage verified)
pubmed full study (doi)
context: Meta-regression analysis of the effects of dietary cholesterol intake on LDL and HDL chole… (The American journal of clinical nutrition 2019) · cited 106x in the literature
"Mean predicted changes in LDL cholesterol for an increase of 100 mg dietary cholesterol/d were 1.90, 4.46, and 4.58 mg/dL for the linear, nonlinear MM, and Hill models, respectively." (abstract, results, passage verified)
pubmed full study (doi)
supports: Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart As… (Circulation 2020) · cited 331x in the literature
"Evidence from observational studies conducted in several countries generally does not indicate a significant association with cardiovascular disease risk. Although meta-analyses of intervention studies differ in their findings, most associate intakes of cholesterol that exceed current average levels with elevated total or low-density lipoprotein cholesterol concentrations." (abstract, results, passage verified)
pubmed full study (doi)

1:12:13 Ronald Kraussneeds contextmoderate

The average LDL cholesterol level in the general population is approximately 115 to 120 mg/dL, and average levels in heart attack patients are only slightly higher.

"the average uh in the population is something like 115 or 120 milligrams per deciliter. Um uh uh if you take a a population of heart attack patients, it's only slightly higher than that." (said at 1:12:13)

National survey data from NHANES (1988-2010) confirm that the mean LDL cholesterol level among US adults declined to approximately 116 mg/dL (matching the speaker's 115-120 mg/dL range). In patients hospitalized with acute coronary artery disease, data from the Get With The Guidelines registry (136,905 hospitalizations) found a mean admission LDL cholesterol level of 104.9 mg/dL, with nearly half of patients having LDL under 100 mg/dL. Thus, while the speaker's broader point that heart attack patients do not present with markedly higher LDL levels than the general population is accurate, their average admission LDL is actually slightly lower (around 105 mg/dL) rather than slightly higher, partly influenced by acute-phase lipid changes and baseline lipid-lowering therapy.

context: Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905… (American heart journal 2009) · cited 332x in the literature
"Of 231,986 hospitalizations from 541 hospitals, admission lipid levels were documented in 136,905 (59.0%). Mean lipid levels were LDL 104.9 +/- 39.8, HDL 39.7 +/- 13.2, and triglyceride 161 +/- 128 mg/dL. Low-density lipoprotein cholesterol <70 mg/dL was observed in 17.6% and ideal levels (LDL <70 with HDL > or =60 mg/dL) in only 1.4%." (abstract, results, passage verified)
pubmed full study (doi)
supports: Trends in lipids and lipoproteins in US adults, 1988-2010. (JAMA 2012) · cited 285x in the literature
"mean LDL-C declined from 129 (95% CI, 127-130) mg/dL to 116 (95% CI, 114-117) mg/dL (P <.001 for linear trend)." (abstract, results, passage verified)
pubmed full study (doi)

Dr. Ronald Krauss on LDL Cholesterol, Particle Size, Heart Disease & Atherogenic Dyslipidemia

Needs context

The effect of dietary cholesterol on blood cholesterol levels and cardiovascular disease risk in the general population is very small to almost unmeasurable.

The average LDL cholesterol level in the general population is approximately 115 to 120 mg/dL, and average levels in heart attack patients are only slightly higher.