I think your point is well taken here, Jim.JimBG wrote:4) As a former risk manager and also having a background in chemical engineering I respect his approach in looking for root causes, taking a fresh problem solving perspective and challenging current dogma. That said I can't help but coming away with the view that based upon his personal experience, engaging a handful very smart folks, doing a great deal of reading of related studies over the last couple of years, as well as accumulating some of his own anecdotal data, that his will overturn key features of the vast body of knowledge accumulated over decades by many scientists, doctors and researchers who have devoted their entire lives to this field. In my opinion that is very unlikely.
In essence, you're pointing to the evidence being limited with regard "the triad" and the existing data that we have with hyper-responders (particularly LMHRs).
This is why I'm actively pressing for more data that examines all three of these axes. We already know low HDLc and high TG are deleterious. They are both components of metabolic syndrome and the definition of atherogenic dyslipidemia.
All that being said, this is ultimately an assertion toward qualitative evidence over quantitative. It wouldn't matter to me if there were 100 studies that focused only on LDLc or 1,000,000 -- if the added stratification of high HDLc and low TG reduced its relevance to nearly zero, it would would make the previous body of evidence far less meaningful in this regard. In a sense, that's already happened with total cholesterol preceding LDLc, and LDLc preceding LDLp. The better metric should overtake the weaker one, particularly if you've already captured it (as is the case with HDLc and TG having already been gathered).
A bigger question for me is why we'd resist examining a more effective measurement in the first place.
