Stratifying Framingham study data by HDL cholesterol reveals a different relationship between LDL and cardiovascular disease risk compared to analyzing LDL alone.

“the point of this graphic is to say your HDL matters and the reason your HDL matters is because your insulin sensitivity matters an LDL must be interpreted in a context it cannot be interpreted in the vacuum”

“if you stratify that same group of people again this is epidemiology by a third variable that is hdl you see a very different relationship”

“you can see a relationship between ldl and incidence or relative risk of cardiovascular disease”

“if you stratify those cohorts by some metric that gives you a sense of insulin sensitivity whether that's hdl fasting insulin triglycerides whatever all of those might give you a sense of insulin sensitivity aka metabolic dysfunction you see the risk of ldl and heart disease essentially vanish or is massively attenuated”

“for instance in the framingham cohort if you have a low hdl which is a proxy for insulin resistance then ldl tracks very well with cardiovascular disease but if you have an hdl of 65 or 85 most of those people are pretty freaking insulin sensitive milligrams per deciliter there's essentially no relationship or a massively attenuated relationship between ldl and cardiovascular disease”

“we talked about the fact that insulin resistance stratification of LDL versus cardiovascular disease is important”