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?

Women, Cholesterol, and Heart Disease: Three of My Favorite Things

These are a few of my favorite thinnnngs.  Sorry, nostalgia.

Women are not men. That should be obvious to everyone. Women have a different balance of sex hormones than men do, they have a higher body fat requirement, they can grow a baby in their bellies for 9 months, and they really like romantic comedies. Despite their inexplicable love for Matthew McConaughey movies, however, the scientific research world likes to pretend these differences don't exist. Over my years of studying cholesterol and cardiovascular disease research, I've noticed a bias here. But it's time to wise up... the research on cholesterol and heart disease shows a stark difference between the sexes. If you're a woman, and there's a 50% chance that you are, then you've been fed a load of shit. Here's why.

I Have High Cholesterol and I Don't Care

If you're a regular reader of this blog, you may know that I love to talk about cholesterol.  You know about my many blog posts on the falsity of the lipid hypothesis, the idea that high cholesterol causes heart disease.  It's been by far the most covered topic on my blog (1, 2, 3, 4, 5, 6, 7, 8, 9, 10).  It's always been a major topic of interest to me, because I feel so strongly that people are being misled when it comes to cholesterol.  It's my view that high cholesterol (recognized by most doctors as higher than 200 mg/dl) is completely overrated as a risk factor for heart disease, and that cholesterol-lowering drugs are unnecessary/useless/potentially harmful for 95% of the population.  Everyone is always so damn worried about their cholesterol, and they don't need to be.  So I'm "that guy".  I'm the guy who scoffs at doctors when they prescribe statin drugs for women with cholesterol levels of 210.  I'm the guy who shakes his head when an otherwise healthy person returns from the doctor's office upset about having high cholesterol.  And I'm DEFINITELY the guy who laughs when you start eating egg white omelets every morning to fix it.  That's just hilarious in so many ways.

What in holy hell...

Now it's one thing to challenge the mainstream ideas on blood lipids; anybody can read books and come up with a take on it.  But it's a totally different animal when you find out that YOU have high cholesterol... very high.

Do Cholesterol-Lowering Drugs Save Lives?

If you read my last post about cholesterol-lowering drugs, then you understand some of the problems that can arise from their use.  Statins can produce some nasty side effects.  But side effects aside, statins save lives right?  I mean, doctors prescribe them to just about everyone, they must be effective.  Not quite... the story is not as simple as it may seem.

When looking at the statin drug clinical trials, it's important to keep a few things in mind.  Firstly, and most importantly... total mortality is more important than heart disease mortality.  If a drug prevents you from dying of heart disease but doesn't affect your chances of dying in general, then that drug is not worth taking.  What's most important is whether or not the drug will extend your life.  Secondly, you must consider that different groups of people may respond differently to the drug.  Women, middle-aged men, the elderly, and those with preexisting heart disease may all respond differently to treatment. 

I'd like to begin by talking about women... both because I like women, and because they don't respond well to statins.  Although many statin studies notoriously neglect to reveal the all-cause death data for women, there are a few studies that do.  Check out the Scandinavian Simvastatin Survivial Study (4S), which was one of the most positive trials to date.  The big pharma folks must have been partying it up when this one came out.  This was a secondary prevention trial, meaning that participants all had pre-existing heart disease (previous heart attack or angina).  For future reference, a primary prevention trial would be an experiment in which the participants did not have pre-existing heart disease.  So, half of them took simvastatin and half of them took a placebo.  The results were great across the board: heart attack numbers were reduced, along with deaths from heart disease and all-cause mortality.  But there was one group that clearly didn't benefit:  women.  Over the duration of the 5.4 years of the trial, 27 (6.6%) of the women taking the statin died, while only 25 (6%) of the women taking the placebo died.  So despite the rest of the data, which was very supportive of statins, there was actually a slight increased risk of death in women from taking the statin.  As you'll soon see, this finding is consistent throughout all of the statin trials, yet it is completely ignored by mainstream medicine.  These drugs simply don't work for women.

The Potential Dangers of Cholesterol-Lowering Drugs

In recent years, the prescription of statin drugs to reduce cholesterol has soared through the roof.  You've heard of them:  Lipitor (atorvastatin), Crestor (rosuvastatin), Zocor (simvastatin), and the like. The supposed benefits of these drugs, as your doctor will tell you, is that they'll reduce your cholesterol levels, hence lowering your risk of heart disease.  I'm sure you all know by now how I feel about lowering cholesterol levels (see this)... but that's beside the point in today's discussion.  I will just say that statin drugs' effectiveness may have been a bit overstated.  Today, though, I'd like to focus on the dangers, or side effects, one may encounter in taking statins.

First, just a little information about how statin drugs work in the body.  Their main function is to block an enzyme called HMG CoA Reductase.  This is one of the enzymes that is involved in making cholesterol in the liver.  So through blocking this pathway, the drug has inhibited the body's ability to make cholesterol molecules.  As a result, your blood cholesterol level goes down, your doctor is happy, and you're happy.  We've finally won the battle against cholesterol!  Yeah... except cholesterol is needed in the body for all sorts of vital processes, like hormone production, vitamin D synthesis, cell membrane structure, and brain function, just to name a few.  Hopefully by the end of this, you'll realize how ridiculous it is to think that blocking an important biochemical pathway like this one is a good idea.