The Link Between Cholesterol and Heart Disease:

Fact or Fantasy?

The link between cholesterol and coronary heart disease is one that seems to be well-established. For many years now we have been told to lower our cholesterol at almost any cost, including the use of statin drugs (eg. lipitor). And although there is research demonstrating that lowering cholesterol with statin medications can prevent heart disease, the conclusion drawn from these studies may be erroneous and leading doctors into giving false, if not hazardous, advice regarding heart disease prevention. It will be my attempt to provide a more balanced view of what leads to coronary artery disease--and it's not a statin deficiency!

Some of the most compelling evidence to support the hypothesis that there is not a correlation between cholesterol and heart disease comes from the Framingham Heart Study. In 1948 a group of men and women from Framingham, Massachusetts became part of a long-term study to track the relationship between diet and lifestyle and heart disease. The participants' children and grandchildren also became part of the study. Although a great deal of useful facts have been obtained from this study, one in particular is apropos of my discussion: Eighty percent of the subjects who developed coronary artery disease had the same total cholesterol concentrations as their healthy counterparts in the study. In other words, the longest running study of heart disease and risk factors has demonstrated that cholesterol is not correlated with heart disease.

One of the most common experimental models attempting to correlate cholesterol and heart disease comes from animal studies. However, not a single animal study has ever been able to cause a heart attack in an animal with high cholesterol alone. What will cause a heart attack is oxidized LDL ("bad" cholesterol). LDL cholesterol becomes oxidized when it is damaged by free radicals. In fact, oxidation of LDL turns LDL into what has been termed an "auto-antigen". The production of these auto-antigens is a necessary ingredient in the development of plaquing/blocking of the arteries of the heart. Animals with high oxidized LDL will have heart attacks. The final ingredient that will assure a person gets blockage of the heart arteries is inflammation.

Coronary heart disease (i.e. atherosclerosis) is a chronic inflammatory disease. The cellular interactions that lead to a narrowing of the arteries of the heart are fundamentally no different than the chronic inflammation seen in other diseases such as rheumatoid arthritis, pulmonary fibrosis, and chronic pancreatitis. For more information regarding inflammation and disease, please reference "Dr. LeRoy's Blog" on my home page.

In brief summary, the amount of oxidized bad cholesterol and the amount of inflammation in your body is what causes heart disease. Your total cholesterol has very little to do with the development of heart disease. My recommendation is to have a thorough diet history and evaluation to determine the likelihood that you are increasing the amount of inflammation in your body as well as to determine the likelihood that you are damaging cholesterol. Everyone should have periodic testing for hsCRP and HgbA1c. High-sensitivity C-reactive protein (hsCRP) is an inflammatory marker found in blood. Hemoglobin A1c (HgbA1c) indicates blood sugar regulation over the preceding 3 months. Insulin resistance and rising blood sugar is very good at increasing oxidation with subsequent damage to LDL cholesterol.