The cholesterol controversy

Closer look at cholesterol

“There are three types of lies,” the American author Mark Twain once said, “Lies, damned lies and statistics.”

The role of cholesterol in the development of atherosclerosis and cardiovascular disease is still marred in controversy and shrouded in statistical mystery.

The original role of cholesterol and heart disease was first brought to public attention in the Framingham heart studies. The Framingham heart study was originally started in 1948 in Framingham, Massachusetts and observed the habits of 5,209 individuals with regards to the future development of heart disease. Scientists quickly discovered that smoking, high blood pressure and high cholesterol dramatically increased an individual’s possibility of getting heart disease.

Atherosclerosis literally means hardening of the arteries. Arteries are hollow blood vessels that take away oxygenated blood from the heart to all tissues and regions of the body. When these blood vessels are damaged from a variety of factors, including smoking and oxidative stress, the inner lining of the arteries become damaged and inflamed. As the body tries to repair the damaged delicate lining, plaque consisting of white blood cells, calcium, protein and cholesterol begins to form. As the plaque progresses, it can completely occlude the inner lining of the artery or rupture off and travel further downstream. Either way, the consequences can be catastrophic. Hardening of the coronary arteries supplying the heart can lead to a heart attack and even death.

The conclusions of the original Framingham studies lead to the widespread public health mandate that less cholesterol is better to help prevent heart disease and other cardiovascular disease.

Cholesterol is a waxy, fatty molecule found only in animal products contain cholesterol. Plant products do not have cholesterol. Diet accounts for between 20% and 40% of cholesterol levels in the blood. The liver produces 60% to 80%. Genetics and family history strongly influence how much cholesterol the liver produces.

Statins are a group of drugs, first marketed in 1987, that dramatically decrease the amount of cholesterol produced in the liver. Statins are among the most commonly prescribed drugs throughout the world. They include names like Lipitor (atorvastatin) and Crestor (rosuvastatin). They are very popular and massively profitable. By 2020, total cumulative worldwide sales of statins were in excess of $1.3 trillion.

Scientific studies on the use of statins to prevent atherosclerosis and heart disease remain somewhat controversial. There appears to be more positive studies, although there are still some negative studies about the role of statins in the prevention and treatment of heart disease.

There are two types of statistical analysis regarding comparison of drug study results: absolute risk reduction and relative risk reduction. As an example, say there is a new drug that lowers cholesterol. In a study of 500 people, half took the new drug and half the people took a placebo. Comparison of the drug versus the placebo showed the drug reduced the incidence of heart attacks by 3%. In this group the incidence of heart attacks was 9% in the placebo group and 6% in the drug group.

The absolute risk reduction of this drug was 9% minus 6% or 3%. However, the risk reduction relative to the placebo is 3% divided by the original 9% and equals 33%. The relative risk reduction of the drug was then calculated to be 33%. Which number sounds more impressive, obviously the larger relative number.

The same type of statistical manipulation applies to statins. Whereas the absolute risk reduction for taking a statin might be 2% or 3% the relative risk reduction would be 30%. Most advertisements of statins say that they reduce your risk of getting a heart attack by about 30%. However, this is a relative risk reduction and the actual percentage is usually somewhere between 2% and 3%.

Statins do not lower your risk of getting a heart attack to zero. They modestly lower your risk of a heart attack.

A further analysis of the Framingham data showed the total cholesterol to HDL (or “good” cholesterol) ratio was a more important risk factor for the development of heart disease than LDL (or “bad” cholesterol) levels.

Clearly, there are multiple risk factors that are related to the development of atherosclerosis and heart disease beyond cholesterol levels. These factors include lifestyle factors like diet, exercise, stress levels, drinking alcohol, nutrient status, triglyceride levels, the degree of inflammation, fibrinogen (or fibrous protein in the blood) and genetics.

A healthy, whole food-based diet, rich in plant material, modest protein like fish and good fats can help prevent heart disease. Limiting fatty animal products and cheese is be a good idea. Eating ample amounts of fruits and vegetables, whole grains and cereals, nuts and seeds is also recommended. Eggs are OK are in moderation. Excessive use of sugar and refined carbohydrates is just as bad, if not worse, than high-cholesterol foods. Additionally, eating foods that keep your blood thin, like garlic, ginger, cayenne pepper and turmeric’s as well as liquid oils from plants like flaxseed, olive oil and fish products is also recommended.

The information provided in this article does not, and is not intended to constitute medical advice. All information and content are for general information purposes only.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.

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About the Author

Doug Lobay is a practicing naturopathic physician in Kelowna, British Columbia.

He graduated with a bachelor of science degree from the University of British Columbia in 1987 and then attended Bastyr College of Natural Health Sciences in Seattle, Washington, where graduated with a doctorate in naturopathic medicine degree in 1991. While attending Bastyr College, he began to research the scientific basis of naturopathic medicine. 

He was surprised to find many of the current major medical journals abounded with scientific information on the use of diet, vitamins, nutritional supplements and herbal medicines.

Doug is a member of the College of Naturopathic Physicians of British Columbia and has practiced as naturopathic family physician for more than 30 years.  He maintains a busy practice in Kelowna where he sees a wide age range of patients with various ailments.

He focuses on dietary modification, allergy testing, nutritional assessments, supplement recommendation for optimal health, various physical therapy modalities, various intravenous therapies including chelation therapy.

An avid writer, he has written seven books on various aspects of naturopathic medicine that are available on Amazon and was also a long-time medical contributor to the Townsend Letter journal for doctors and patients, where many of his articles are available to view on-line. He has also given numerous lectures, talks and has taught various courses on natural medicine.

Doug enjoys research, writing and teaching others about the virtues of natural health and good nutrition. When not working, he enjoys cycling, hiking, hockey, skiing, swimming, tennis and playing guitar.

If you have any further questions or comments, you can contact Dr. Lobay at 250-860-7622 or [email protected].

The views expressed are strictly those of the author and not necessarily those of Castanet. Castanet does not warrant the contents.

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