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Rethinking cholesterol’s role in heart disease

Is cholesterol the chief culprit behind heart disease? For decades, Americans have been told that to lower their risk of a heart attack, they had to lower their cholesterol levels, either through diet or drugs. But the old cholesterol theory is crumbling.

In recent months, there have been some dramatic changes in public health policy. For one thing, the new Dietary Guidelines for Americans don’t emphasize avoiding cholesterol in your food. Instead, Americans are advised to limit saturated and trans fats, added sugars and sodium. Eggs are now considered part of a healthy eating pattern (Dietary Guidelines for Americans, 2015).

The American Heart Association and the American College of Cardiology issued their own guidelines late in 2013. These organizations recommend that if diet doesn’t lower blood cholesterol, statins are the solution. According to their guidelines, at least one-third of American adults would be taking a prescribed statin. Nearly everyone between the ages of 66 and 75 would be on one of these drugs (JAMA Internal Medicine, January 2015).

But not all cardiologists agree that lowering blood cholesterol is the most important approach to preventing heart disease. Robert DuBroff, M.D., is a cardiologist and lipid specialist at the University of New Mexico. He has pointed out that high-risk populations don’t consistently benefit from statin therapy (American Journal of Medicine, March 2016). In his view, doctors do not have a good way to tell who might benefit from taking a statin to prevent heart disease. Clinical benefits, particularly survival, don’t correspond well to the amount that a statin lowers “bad” LDL cholesterol (Preventive Medicine, April 2016).

Dr. DuBroff, together with French physician Michel de Lorgeril, M.D., who oversaw the ground-breaking Lyon Heart Study in the 1990s, has written: “We conclude that the expectation that CHD [coronary heart disease] could be prevented or eliminated by simply reducing cholesterol appears unfounded. On the contrary, we should acknowledge the inconsistencies of the cholesterol theory and recognize the proven benefits of a healthy lifestyle incorporating a Mediterranean diet to prevent CHD” (World Journal of Cardiology, July 26, 2015).

If cardiologists can’t agree on the importance of lowering cholesterol with statins, it is hardly any wonder that patients are confused. What else can people do to keep their hearts healthy?

There are many nondrug approaches that are beneficial. You can learn more about them in our Guide to Cholesterol Control and Heart Health. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (71 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. C-8, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

Physical activity is important for health. If statins cause muscle pain or weakness that interferes with exercise, that could be counterproductive. So would be elevations in blood sugar. Diabetes is one of the leading causes of heart disease and a known complication of statins.

A Mediterranean diet, as Drs. de Lorgeril and DuBroff mentioned, also is great for the heart. A large randomized trial called PREDIMED showed that this type of diet with lots of olive oil or nuts prevented heart disease in high-risk individuals (New England Journal of Medicine, Apr. 4, 2013). Such a diet rich in vegetables and fruits also is helpful in reducing (not increasing) the risk of diabetes (Journal of Nutrition online, March 9, 2016).

Joe and Teresa Graedon answer letters from readers. Write to them via their Web site: www.PeoplesPharmacy.com.

 

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