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Comment by DiabloD3 | Hacker News Reader

Unfortunately, this study failed to measure cholesterol oxidization.

20 years ago, when this study started, it was still considered bleeding edge science to even consider that (or a proxy, particle size), and they recorded all of the wrong values

A quick glance through the paper does not indicate they measured particle size. It also seems they may have measured LDL/HDL/TG fraction, but then did nothing with it (which basically puts this paper at the technological level of the 1950s).

Neither total cholesterol nor LDL/HDL/TG fractions can accurately predict mortality, but particle size can. LDL-P et al tests are quickly becoming the norm as younger doctors enter the field, and their education is more up to date than their older peers.

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Actually Apo B is a better predictor for cardiovascular risk (and, AFAIK, the actual thing that injuries your arterial wall): "Based on current research, Apolipoprotein B has emerged as the superior marker for assessing cardiovascular disease risk. LDL particle size also has quality evidence behind it, but as it’s a metric that’s not yet as standardized nor as strongly predictive as ApoB, ApoB remains a better assessment of heart health than LDL particle size alone." https://blog.insidetracker.com/impact-ldl-particle-size-apob...

There is a 6 hour lipid series in YouTube where they go into the details: https://youtu.be/5iGl3iPZDis?si=fzL6zmX-iqkF7wF-

6 hours of a niche science topic? Don't threaten me with a good time.

Cholesterol tests are common but the better test is to measure APOB. Something that’s not usually covered by insurance and many doctors don’t know about because it’s newer.

I noticed heart disease was called out as a co-morbidity to high cholesterol. A lot of cardiovascular disease is caused by excess LDL cholesterol.

It's a shame that it needs younger doctors for things to change if the science and technology is already there.

https://en.wikipedia.org/wiki/Planck%27s_principle

As a complete layperson, it's interesting how eerily intuitive particle size is as a measure of risk: "bigger particles clog up your blood vessels more".

I understand that the diameter tells whether the LDL is oxidized, which would be bad.

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