Thursday, October 17, 2013

Does High Cholesterol Really Cause Heart Disease?

Total cholesterol level is probably the health related number that most people are familiar with. Many people know their number and accept as an article of faith that lower total cholesterol improves their odds of avoiding cardiovascular disease. But is it really so?

In fact cholesterol (both the "bad" LDL kind and the "good" HDL) play important roles in the body. Cholesterol is required for the building of healthy new cells, and is closely involved in the production of Vitamin D and several hormones. It functions as an anti-oxidant as well as catalyzing the production of bile - which allows us to digest fats. It helps us absorb calcium and is involved in effective synaptic function in the brain. None of us would live very well or very long without it.

More to the point, cholesterol, specifically LDL cholesterol, is used by the body to repair inflammation induced lesions in the vascular system. "Dr. Mary Enig, suggests that blaming cholesterol for heart disease is something akin to blaming firefighters for fires. The key to stopping heart disease is to stop the lesions (fires) in the arteries from occurring in the first place (Full article)." And the key to that is reducing inflammation, not lowering cholesterol. The famous Framinghan Heart Study results show that about half the participants who had high cholesterol levels suffered no coronary events, while about half the people who did had cholesterol levels well within the normal range.

Meanwhile, the evidence that lowering cholesterol levels reduces the incidence of cardiovascular disease is at best mixed. There is some (although not conclusive) support for the idea that people with existing cardiovascular disease benefit from lowering cholesterol (primary prevention), but little support for the proposition that it lowers risk in people without any pre-existing condition (secondary prevention). The primary medical treatment for high cholesterol is the administration of statin drugs and "the National Cholesterol Education Program revised its guidelines to recommend statins as primary prevention. Although the panel cited randomized trials to support statin therapy for primary prevention of cardiovascular disease, a report in Lancet notes, "not one of the studies provides such evidence." Journalists have questioned the interests of the doctors who made such recommendations, as eight of the 9 doctors on the panel were discovered to have been paid by statin manufacturers. (Full article)" More recently, AstraZenica, the manufacturer of the statin Crestor, has petitioned the Food and Drug Administration for approval to recommend Crestor as a preventive measure to people as young as 25 with no personal or family history of heart disease. According the the Journal of the American Medical Association, the use of statin drugs has increased 10-fold in people 45 years of age or older.

Statin therapy involves known risks and numerous serious side effects. It is one thing to take this risk in exchange for a significant benefit - avoiding cardiovascular disease. But if in fact the culprit is inflammation, then the whole cholesterol obsession starts to feel like a scam - albeit a very profitable one. As always, educate yourself and make up your own mind. Caveat patientes.

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