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Association between cardiovascular risk factors and coronary artery disease assessed using CAD-RADS classification: a cross-sectional study in Romanian population
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  • Published on:
    Response letter to Ravnskov U et al "Dyslipidemia is an unlikely cause of atherosclerosis"
    • Loredana Elisabeta Popa, Radiologist Department of Radiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureş,
    • Other Contributors:
      • Bianca Petresc, Radiologist
      • Raluca Alina Rancea, Cardiologist

    We appreciate the authors’ interest for our paper, and we would like to thank them for the opportunity to discuss the problems raised in their letter (1).

    First of all, we would like to emphasize that in our study we didn’t try to investigate the pathophysiology of atherosclerosis, but tried to see how the generally accepted risk factors of atherosclerosis correlate with significant coronary heart disease evaluated by CAD-RADS score in the Romanian population (2). The design of our research was cross-sectional, retrospective, therefore our purpose was not to establish the causality between dyslipidemia and cardiovascular disease. We agree with the authors that there is a difference between causality and association and our current study was based on evaluating the association between the presence of risk factors and the burden of atherosclerotic coronary disease evaluated using CCTA method. We chose dyslipidemia among the atherosclerosis risk factors studied based on the most current guidelines on cardiovascular disease prevention at the time (3).

    Regarding the pathophysiology of atherosclerosis, the role of lipids and lipoproteins in the development of atheromatous plaque is proven by many studies (4-7). This complex process, based on an inflammatory response, is initiated by the infiltration of apoB containing lipoproteins into the arterial wall, which cause wall injuries and promote infiltration of monocytes into the subendothelial space. Secondly, the ma...

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    Conflict of Interest:
    None declared.
  • Published on:
    Dyslipidemia is an unlikely cause of atherosclerosis
    • Uff'e Ravnskov, Independent researcher Not affiliated to any institution
    • Other Contributors:
      • David M Diamond, Professor Psychology, Molecular Pharmacology & Physiology)
      • Sherif Sultan, Professor, Cardiac surgery

    The study by Popa et al. (1) is potentially of value in identifying adverse influences on cardiovascular health. Their study, however, suggests that dyslipidemia causes cardiovascular disease (CVD). We feel compelled to show that the broader literature is not consistent with this perspective and that their finding of an association between dyslipidemia and CVD is influenced by a methodological flaw in their design.

    First, there is no evidence that dyslipidemia causes atherosclerosis. Already in 1936 Lande ́ and Sperry found that when corrected for age, healthy people with low total cholesterol (TC) were just as atherosclerotic as healthy people with high TC (2) and their finding has been verified and replicated later by many research groups (2). A strong contradiction has also been documented by sixteen angiographic trials where the authors had calculated exposure-response, which was present in only two of them (2). Furthermore, a study of the coronary arteries of 304 asymptomatic women by Hecht and Superco showed that the role of high LDL-cholesterol (LDL-C) is questionable as well. By using electron beam tomography, they found that neither the calcium percentile or the calcium score were associated with LDL-C (3). Also contradictory is, that In five studies of people with familial hypercholesterolemia there were no association between degree of atherosclerosis and LDL-C (4).

    Second, numerous observations and experiments have shown that dyslipidemia does no...

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    Conflict of Interest:
    None declared.