Certain diseases can lower LDL cholesterol, potentially creating reverse causality in studies associating low LDL with higher mortality.

“reverse causality there's going to be some people who will say in it's fair to explore this some diseases are going to bring down your LDL exactly this is the main criticism here correct so some cancers for example many other things that that can result in say organs shut down those are things that you need to be mindful of it could bring LDL down and therefore if you're let's say Paul you've got one of these diseases in your you know five months away from dying but you've got your blood panel and includes lower LDL cholesterol well now that's getting associated with your higher mortality along with everybody else”