Non-HDL cholesterol & cardiovascular disease

Background

My first economics lecture at Cambridge University opened with the following joke: an economist, a marine biologist and a physicist are stranded in a boat with canned food and no can opener. They are discussing how they can get to the food to survive. The physicist suggests the angle of projection needed to throw a can at a sharp object in the hope that it will open. The marine biologist suggests dangling the can over the side of the boat to get fish to bite through the metal. The economist says, “let’s assume we’ve got a can opener.” At the end of three years of studying, we realised many a true word is spoken in jest. Economic modelling, as with modelling in any field, depends entirely on the assumptions.

Introduction

Every now and again I receive several emails about the same media story. That then tells me what the Monday note topic needs to be. That happened this week when a number of people sent me the latest cholesterol headlines “Heart experts demand checks for cholesterol from age of 25” (Ref 1). “Check your cholesterol from age 25” (Ref 2).

The paper behind these headlines was published in The Lancet on 3rd December 2019. It was called “Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium” (Ref 3). Among the many authors, competing interests were declared with the following companies (many companies appearing several times): Abbott Australasia, Abbott Laboratories, Alphapharm, Amgen, AstraZeneca, Aventis Pharma, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Esperion, GlaxoSmithKline, Janssen-Cilag, Medtronic, Merck Lipha, Merck, Mylan, Novartis, Novo Nordisk, Pharmacia and Upjohn, Pfizer, Regeneron, Roche, Sanofi Synthelabo, Sanofi, Servier, Servier Laboratories, Siemens, Singulex, The Medicines Company and ThermoFisher Scientific.

The goal of the study was to investigate “the relevance of blood lipid concentrations to long-term incidence of cardiovascular disease” (CVD). The first point to note is that this was a risk-evaluation and risk-modelling study. Economic modelling depends on the assumptions, so let’s look at what was done, what was found and what was assumed…