Is there a proven link between cholesterol and heart disease?
Should we be scared of our cholesterol, or celebrate it?
This study says no link between cholesterol and heart disease in the over 60's. Is it time to ditch the statins?
Top British cardiologist, Dr Aseem Malhotra suggests it may be.
What does cholesterol do in our body?
- Cholesterol is required by almost every cell in our bodies. It is so vital we are able to manufacture it. Cholesterol is predominantly made by your liver. Cholesterol is so vital we manufacture the bulk of the body's requirements.
- Cholesterol is the structure that is the base of all our sex hormones, bile acid and Vitamin D is made from. Cholesterol maintains cell walls, allows cellular communication and transportation of substances.
- Cholesterol aids the body in fighting infection. When there is an infection present in the body, HDL goes down because it is used to fight the toxins, and this may be one of the reasons why cholesterol is found at the site of inflammation. But this is not to say that cholesterol is to blame for the inflammation, in fact, it could be the opposite, it is present to calm the inflammation.
Does saturated fat clog arteries?
According to this study published in the British Medical Journal, they say no, saturated fat does not clog arteries. In fact, they go even further to suggest that coronary heart disease is actually a chronic inflammatory condition.
No statins are required. The risks of developing heart disease can be effectively reduced from healthy lifestyle interventions.
- LDL cholesterol risk has been exaggerated.
- A high TC to high-density lipoprotein (HDL) ratio is the best predictor of cardiovascular risk.
- Coronary artery disease is a chronic inflammatory disease.
- Preventing the development of atherosclerosis is important but it is atherothrombosis that is the real killer.
- postmenopausal women with CHD, greater intake of saturated fat was associated with less progression of atherosclerosis whereas carbohydrate and polyunsaturated fat intake were associated with greater progression.
- Coronary artery disease pathogenesis and treatment urgently requires a paradigm shift.
Does cholesterol really predict heart disease?
Cholesterol is a poor predictor of heart disease. Half of those with heart disease have 'normal' cholesterol levels. Half of those with 'high' cholesterol levels have healthy hearts. Most heart attack victims have cholesterol within the "normal" range.
And should we eat a low-fat diet or a low-carb diet? The World Heart Federation president, Salim Yusuf, has presented the data from the PURE study on diet and cardiovascular disease. He concluded that fats protect us and carbs are harmful.
Inflammation is the real enemy of heart disease.
Should you worry about high cholesterol? You need to talk to your health care practitioner to discuss your risk factors. You may also wish to have a calcium scan which is a true reflection of your heart health, rather than a predicted ratio that has been calculated using population data.
What do the studies say?
"For decades, the mainstream view has been that an elevated level of total cholesterol (TC) is a primary cause of atherosclerosis and cardiovascular disease (CVD). There are several contradictions to this view, however. No study of unselected people has found an association between TC and degree of atherosclerosis". (1)
"Moreover, in most of the Japanese epidemiological studies, high TC is not a risk factor for stroke, and further, there is an inverse association between TC and all-cause mortality, irrespective of age and sex". (2)
"It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly..." the study published in the British Medical journal decided to study this further.
The BMJ study
They identified 19 studies, with a total of 68094 elderly participants where all-cause mortality was recorded.
Their conclusion was high LDL-C is inversely proportional with mortality in most people over 60 years. This is inconsistent with the current cholesterol hypothesis.
"Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis."
The study suggests "re-evaluation of guidelines recommending pharmacological reduction of LDL-C" ie: statins.
Is high LDL-C beneficial?
Whilst most people are scared by the very word cholesterol, the health benefits are rarely discussed.
- Lipoproteins are part of the immune defence mechanism. They bind and inactivate microbes. (3).
- High LDL may be protective against infection and atherosclerosis. (4).
- LDL may have a role to play in protection against those cancers that are caused by viruses. (5)
- To read the BMJ study - Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
- Cholesterol myth - inflammation is the killer
- Cholesterol - 20 reasons not to fear cholesterol
- 1: Is atherosclerosis caused by high cholesterol?
- 2: Towards a Paradigm Shift in Cholesterol Treatment. A Re-examination of the Cholesterol Issue in Japan
- 3: Lipoprotein Aggregates Complexed with Microbial Remnants and LDL Autoantibodies
- 4: High cholesterol may protect against infections and atherosclerosis
- 5: Virus induced inflammation and cancer development