Most Heart Attack Victims Have Normal Cholesterol Levels

It's been too long since I've spoken about cholesterol, too long I tell you. For those of you who don't know, I would sum up my view on cholesterol like this: it's the most overhyped risk factor for heart disease there is. All you hear in the media is "Watch your cholesterol!" or "Cheerios lower cholesterol!" or "This food is cholesterol-free, so it's good for you!". Bollocks. Bollocks I say.

First of all, the cholesterol in the food you eat barely has any effect on the cholesterol in your blood, if it has any effect at all. And second, let's set the record straight on "high cholesterol"... please for the love of God, quit worrying about it. Your total cholesterol is just about meaningless unless it's taken in context with your triglycerides, HDL, and LDL... even better, your LDL particle number. Despite having no real, accurate clinical implications though, "high cholesterol" has taken on this sort-of boogey man role, scaring every health-conscious person into Lipitor land.

Anyway, I came across something today that was just too good not to write about; this stuff needs to be shared. This study was designed to analyze lipid-lowering therapy, but that's not the part I want to talk about here; it's the cholesterol levels of the patients that piqued my interest. The researchers examined 65,396 patients hospitalized for heart disease (heart attack or angina) across the United States. Below you'll find a screenshot of the baseline blood lipid data, taken within the first 24 hours of admission. You would expect, based on what you think you know, that heart disease patients must have had high cholesterol, right?

Average blood lipid values upon admission among all study participants.

Nope. On average, their cholesterol was 170.1 mg/dl, well below the high limit of 200. If any of these people had visited the doctor for a check-up a week before their hospitalization, the doc would have looked at these numbers and said "Steve, your cholesterol is great! Keep up the great work!" Assuming his name is Steve.

But things weren't great. Each of these people experienced an acute coronary event that required hospitalization and very well could have ended their lives. It's irresponsible that we're putting so much stock into cholesterol values when they clearly are NOT a good indicator of heart disease risk.

Sometimes it only takes one little piece of data, like this one, to completely change your beliefs on cholesterol and heart disease. I hope this provided the baseball to your brand new home window.

But what does this mean??
Now, there's an excellent chance that many of these people were already taking a cholesterol-lowering drug. There's no data in the study to show whether this is true, but since so many people are on them, it's very likely. So let's say for a moment that they were on statins. Say their normal cholesterol levels are around 220 mg/dl, and the statins bring it down to a more friendly-looking 170. Well, this only destroys the cholesterol and heart disease connection even more doesn't it? First off, it doesn't say much about the efficacy of the drugs. But also, it shows that reducing cholesterol from "high" back into "normal", at least via these mechanisms, is useless.

Okay, let me say it another way... if high cholesterol is the cause of our problems, lowering it should reduce our risk, regardless of the manner by which we do so. If it is not the cause, and it is just an indicator of a problem, then pharmacologically lowering it will NOT reduce our risk. It will, in fact, just make things appear to be fine when they are not.

It's sort of like when we get sick and we get a fever. We may take over-the-counter meds to reduce the fever; it makes us feel better and it takes away one of the symptoms of our illness. But we forget that the fever is an important part of our body's defense mechanism to fight a bacterial infection... bacteria don't like the heat. We may feel a little better, but we remain just as sick as we were before, and we've now likely prolonged our sickness by messing with our body's natural defense mechanisms.

The fever is like cholesterol, the symptom. The bacterial infection is the root cause. Got it? Okay it's not a perfect analogy, but you get the point.


What is the root cause of heart disease then? If not total cholesterol, what should we focus on? Well that's a big can of worms... there are many factors that go into it. Stay tuned next week for a comprehensive guide on how to prevent heart disease!