Cholesterol vs The World!
There has been a lot of talk in recent times of the cholesterol myth surrounding the issue of cholesterol’s relationship to heart disease. I am going to attempt to give cholesterol, a hormone found in every human being, a fair trial. You today are going to be the jury, so your decision based on the evidence I provide is for your own judgment on the public world wide notion that high cholesterol causes heart disease. With this information you should be able to debunk the cholesterol myths, the true causes of heart disease and have a better understanding of what really is the true cause of heart disease and its potential cure.
Structure Of The Presentation.
First I will attempt to give cholesterol a fair trial based on a large collection of evidence I have gathered from both sides of the argument.
Then I will try to explain what alternative theories there are for the cause of heart disease.
The take home message is my belief that a more holistic approach is the best method for lowering risk of heart diease and everyone in the room today has a very powerful and effective skill already to help people.
I am going to play both the prosecuter and the defendant, so please bear with me as ive never acted before, but should make a potentially boring and complex subject a bit more fun to digest.
Firstly a little disclaimer…
I have not done any official clinical trials myself, and am merely providing evidence provided by reputable sources.
So this is not medical advice and should not be used as such. It is merely information to give you a better understanding of cholesterol, how it affects our body and its relationship with heart disease.
Introduction
I am a pharmacist, health and wellness consultant and sound therapist based in London UK.
Over the last 4 years I have been focusing my efforts on understanding the methods of disease prevention, rather than disease maintenance which the current pharmaceutical establishment is focused on.
By disease maintenance I mean the design and use of medication to control symptoms of patients rather than methods to prevent disease from occurring in the first place.
Disease maintenance never really establishes the cause of the disease or even its cure, it instead helps to control a disease for the duration of a patients life.
This would be fine if the medication used did not have undesirable side effects which could actually make a patient feel worse than the disease itself.
I got motivated towards disease prevention due to the incredible numbers of complaints received from my patients about the often horrendous side effects they were suffering from on a daily basis.
In particular one class of drugs called statins, which I will discuss during this trial at great length, moved me the most.
In my clinical experience as a pharmacist, 1 in 5 patients who have taken simvastatin based on the Medicine Use Reviews I undertook (the cheapest and most widely prescribed statin) have suffered from a nasty side effect from the drug such as muscle pain, extreme muscle cramps, significant tiredness and memory loss.
I was so sad to see so many of my patients suffer, I really wanted to find a way to help them get off their statin medication completely.
The good news is that I found a way of doing this with some fantastic results. In a nutshell it involved giving self empowering lifestyle information to my patients, that unfortunately our rather busy G.Ps just didn’t have any time to do so themselves, or more likely that they just didn’t know what to tell them.
After this trial is over, I will reveal to you my system for empowering my patients that has led them to not be dependent on their statin medication and has had the added benefit of giving them a new lease of life, lower blood pressure, healthier weight and more strength and vitality.
Background
Before we move on to the trial. I want to first give you a background on the current view on the mechanism for how heart disease occurs, what cholesterol actually is and does. I believe that because the majority of the worlds population does not even know the basics of how our body works, it is much easier to mislead us, when we are ignorant to the facts.
What is the generally accepted view of heart disease?
Heart disease is actually a very vague term to use. There are many different types of heart disease such as myocarditis, pericarditis and ventricular hypertrophy. But the most important one to remember and what kills most people is coronary heart disease.
In coronary heart disease the important arteries and veins to take note of are the coronary arteries and veins. Your heart also needs to have a rich blood supply to ensure it receives enough nutrients and oxygen to function.
When your coronary artery gets blocked the result is the dreaded heart attack!
When your coronary artery cannot supply enough oxygen to your heart, the result is a often dramatic and intense pain in your chest, known as angina.
If the blood flow via your coronary arteries is affected for a prolonged time, your heart tissue can actually start to die.
So heart disease is really a disease of your coronary arteries and is often called artherosclerosis.
Arthero means the build up of grey-white/fatty gunk in your artery walls also known as plaques. Sclerosis means general thickening and hardening.
Plaques are generally thought to progress from the initial “fatty streak”, to getting bigger and thicker, then eventually calcifying, turning your arteries in to still, almost bone like tubes. This process usually takes many years to occur.
But it is not the still calcified plaque that we have to worry so much about. It is actually the intermediate stage, known as the “unstable plaque” During the plaques development it turns into something that resembles a cyst. Its semi liquid center is full of a goo like substance made up of fats, dead cells and broken down bits of blood clot.
The big problem about this type of plaque is if the thin wall surrounding the goo breaks down. If this actually happens, a strong signal is sent to your bodies clotting system and this results in a thrombus (blood clot) forming over the plaque. If this clot is big enough it can actually stop the blood flow to the section of your heart it is supposed to supply. So the heart muscle will become starved of oxygen. This is known as myocardial infarction which is pretty much what we know as a heart attack.
It is this malfunction in your coronary arteries that is known as coronary heart disease and cholesterol, the natural substance we all make, the subject of countless cholesterol myths, is standing on trial today as the prime suspect for its cause!
What Actually Is Cholesterol?
Cholesterol is needed for the following life giving functions:
Does it not seem strange that we are all desperately trying to lower something in our body that is clearly very beneficial?
So now, lets begin the trial..
Cholesterol vs The World
Cholesterol today is being blamed for crimes against humanity, for increasing your chances of dying from heart disease. What are the myths surrounding cholesterol and is cholesterol to blame here, or is it something else?
First I would like to call up the prosecution to state their case.
The case for high cholesterol being the primary cause of coronary heart disease:
I would first like to call to the witness stand, the NHS, UK
This is based on the evidence they supply for cholesterol causing heart disease on their website, http://www.nhs.uk
‘Good’ and ‘bad’ cholesterol
Cholesterol cannot travel around the body on its own because it does not dissolve in water. Instead, it is carried in your blood by molecules called lipoproteins.
The two main lipoproteins are LDL and HDL.
- Low-density lipoprotein (LDL). LDL is the main cholesterol transporter and carries cholesterol from your liver to the cells that need it. If there is too much cholesterol for the cells to use, this can cause a harmful build-up in your blood. Too much LDL cholesterol in the blood can cause cholesterol to build up in the artery walls, leading to disease of the arteries. For this reason, LDL cholesterol is known as ‘bad cholesterol’, and lower levels are better.
- High-density lipoprotein (HDL). HDL carries cholesterol away from the cells and back to the liver, where it is either broken down or passed from the body as a waste product. For this reason, it is referred to as ‘good cholesterol’, and higher levels are better.
The amount of cholesterol in the blood (including both LDL and HDL) can be measured with a blood test.
Your doctor or nurse may also measure your level of triglycerides. Triglycerides are the fats you use for energy and come from the fatty foods you eat. You store what you do not use in the fatty tissues of your body. Excess triglycerides in the blood also increase heart problems.
Normal cholesterol level
Blood cholesterol is measured in units called millimoles per litre of blood, often shortened to mmol/L.
The government recommends that cholesterol levels should be less than 5mmol/L.
Evidence strongly indicates that high cholesterol levels can cause narrowing of the arteries (atherosclerosis), heart attack and stroke.
This is because cholesterol can build up in the artery wall (see Symptoms), restricting the flow of blood to your heart, brain and the rest of your body. It also increases the chance of a blood clot developing.
Your risk of coronary heart disease (when your heart’s blood supply is blocked or disrupted) rises as your blood’s cholesterol level increases. Other factors, such as high blood pressure and smoking, increase this risk even more.
Who is at risk?
There are many factors that can increase your chance of having heart problems or stroke if you have high cholesterol. These are called risk factors.
- Some risk factors, such as an unhealthy diet and smoking, can be changed by altering your lifestyle.
- Some risk factors, such as having diabetes or high blood pressure, can be treated with medication.
- Some risk factors, such as having a family history of stroke or heart disease, cannot be changed.
A number of different factors can contribute to high blood cholesterol, including:
Lifestyle factors,
Treatable factors, and
Fixed factors.
Important point on the NHS site to consider:
Unhealthy diet. Some foods, such as liver, kidneys and eggs, contain cholesterol (known as dietary cholesterol). However, dietary cholesterol has little effect on blood cholesterol. More important is the amount of saturated fat in your diet. Foods that are high in saturated fat include red meat, meat pies and sausages, hard cheese, butter and lard, pastry, cakes, biscuits and cream, including sour cream and crème fraîche.
“They say that an unhealthy diet is a risk factor for causing high cholesterol. Then they say, dietary cholesterol has little effect on blood cholesterol, it is instead saturated fat that is the problem. Could I please ask the prosecution what is the link between saturated fat in the diet and your cholesterol levels?”
The Prosecution:
The liver turns saturated fat into cholesterol.
The Defendant:
The fundamental building block for cholesterol is a substance called Acetyl Coa
1. It contains phosphorous, sulphur and nitrogen (none of which are found in fats, they are found in proteins)
2. It has several ring structures none of which are found in fats.
Could you please explain the mechanism and proof of the action of the liver.
The Prosecution:
I am actually finding it very difficult to play the prosector here under this scrutiny. After doing a big deal of research on pubmed and various other sources, the only theory for this mechanism is that the liver has an amazing ability to change one molecule into an entirely different molecule. It can turn protein into sugar, sugar into fats, and now supposedly it can turn saturated fats into cholesterol.
The Defendant:
If saturated fat is such a big deal, why is it that the only type of fat that the liver synthesizes is “saturated fat”? Going by your hypothesis why would the liver create a dangerous fat inside your body that will then lead to a rise in your cholesterol levels that leads to heart disease? Is the liver that stupid? Or could it be that saturated fat actually has no effect on your risk of heart disease and cholesterol levels at all?
Most of the fat in our diet is transported directly to our fat cells, traveling inside chylomicrons a type of lipoprotein. There is no proof that fat that does manage to reach the liver actually has an impact on cholesterol levels.
You have also made it clear that it is the high LDL levels that are to blame for heart disease, not cholesterol itself. VLDL also known as triglycerides (you will often be given this reading in your blood test) is made in the liver and is used to transport both fat and cholesterol out of the liver and deliver both substances around the body. How is it that saturated fat raises VLDL when in reality the research shows that it is actually carbohydrate consumption that does this?
I must also refer to a study by Duke University researchers who presented these findings to the American Heart Disease Association in Chicago.
University researchers randomly assigned 120 overweight volunteers to the Atkins diet, where volunteers reduced their carbohydrate intake to less than 20 grams a day, with 60% of their calories coming from fat.
After 6 months, participants on the Atkins diet had lost 31 pounds, had an 11 percent increase in HDL (good cholesterol) and a 49% drop in their triglyceride levels.
This clearly shows the opposite, a high fat diet actually lowers so called harmful LDL and increases beneficial HDL.
Where does this saturated fat-heart disease hypothesis arise from?
The Prosecution:
Calling first witness to the stand, Pathologist Rudolph Von Virchow, Berlin, Mid 19th Century.
(He is a bit old, and a bit grey but we managed to dig him out for today’s trial)
Looking into the arteries of corpses I discovered a great amount of cholesterol in the plaque of their arteries. The only possible place I can see this coming from is the blood.
Calling the second witness to the stand, Nikolai Anitschkov, Russia.
I fed rabbits a high cholesterol diet, their arteries thickened and filled up with cholesterol. So this is what must happen in humans too.
The Defendent:
Objection your honour
How can you compare a rabbit to a human? Rabbits are herbivores, they do not normally eat a high cholesterol diet ever, and the thickening they get in their arteries is not the same type as found in humans. How can this be a fair comparison?
The Prosectution:
We have more evidence to support this. Could we please call Ancel Keys, January 26, 1904 – November 20, 2004) was an American scientist who studied the influence of diet on health. Famous for the meditarranan diet
Ancel Keys: In 1954 the World Health Organisation called its first expert committee on the Pathogenesis of Artherosclerosis to consider the rising epidemic of coronary disease and heart attacks. Sir George Pickering, Knight of the Realm asked me to give him my single best piece of evidence in support of the diet-heart hypothesis. At this point in time I could not give an answer that what accepted. This motivated me to carry out my own personal study, called The Seven Countries Study which is now widely accepted as the basis for this hypothesis
I took 7 countries and looked at their saturated fat consumption and found a straight line relationship between heart disease, cholesterol levels and saturated fat intake.
This 7 countries were:
Italy
Greece
Former Yugoslavia
Netherlands
Finland
USA
Japan
The Defendant:
Objection your honour
So the entire 7 countries study is based on just 7 countries that you personally chose as the title suggest.
Dr Kendrick 14 Country Study:
Instead of just taking 7 countries as Ancel Keys did. Dr Kendrick took 14 countries and performed the same test. All data was gathered from the World Health Organisation.
Every single one of the 7 countries with the lowest consumption of saturated fat has significanty higher rates of heart disease than every single one of the seven countries with the highest saturated fat consumption.
Also how can you support a whole hypothesis by comparing just one variable, saturated fat intake against rate of heart disease. There are so many other factors to consider, such as smoking, alcohol consumption, exercise, gender, race and so on.
The Prosecution:
In 1948 the Framingham Study was set up in the town of Framingham, Boston. The whole population was screened for factors that might be involved in causing heart disease. This study continues until today. The findings are that cholesterol in the blood is the best predictor of someone dying of heart disease.
It was also found that people with a genetic condition known as Familial hypercholesterolaemia (FH) – an inherited condition of high levels of blood cholesterol (LDL) could die from heart disease as young as 5 years old.
The Defendant:
Calling Dr George Mann, 1970’s
I studied the masai villagers in Kenya in the 1970’s. They have the highest saturated fat and cholesterol ever discovered. Their diet consists mainly of milk, meat and fat. They should by this hypothesis have the highest rates of heart disease, but in fact it is practically zero.
Now lets look at heart disease rates between 1928 – 55 when the UK underwent food rationing after WWII.
For 12 years saturated fat consumption was severely restricted
Fruit and fish consumption increased
The rate of heart disease nearly trebled.
Now for another paradox:
The French Paradox:
The French:
- Eat more saturated fat than we do in the UK
- They smoke more that we do in the UK
- They do less exercise
- Have similar cholesterol/HDL and LDL levels
- Have a similar average blood pressure
- Similar rate of obesity
- Consume more saturated fat than any other nation in Europe
- But have ¼ of the rate of heart disease
The only other country to have such as super low rate of heart disase is the Swiss and they have the second highest consumption of saturated fat in Europe.
The Prosecution:
Objection your honour
The French consume more garlic, red wine and vegetables that are all shown to help prevent heart disease.
In 1994 a meta analysis was published by Silagy. He looked at the effect of garlic on blood cholesterol levels and concluded:
There is a 12% reduction with garlic therapy of the total cholesterol between garlic treated subjects and those receiving placebo. This evidence comes from a systematic review of published and unpublished randomized controlled trials of garlic preparation of at least 4 weeks duration. Studies were identified by a search of MEDLINE and ALTERNATIVE MEDICINE electronic database and through direct contact with garlic manufacturers.
The Defendant:
Objection!
Do you not think that basing this evidence on trials conducted by garlic manufacturers who have a vested interest in garlic sales could be unfair?
In fact there are no proper trials that have ever been done, meaning randomized controlled clinical trials that red wine, garlic or vegetable consumption actually does lower cholesterol levels in the blood.
Except for Silagy himself whose evidence you have used to explain the French Paradox, who performed one after his initial meta analysis where he concluded:
There were no significant differences between the groups receiving garlic and placebo in the mean concentrations of LDL.
The Prosecution:
We have more evidence to explain these paradoxes:
The inuit Eskimos have a high saturated fat intake and very low rate of heart disease, but this can be explained by their high consumption of beneficial Omega-3 from fish.
The Defendant:
Here are some more major paradoxes to the prosecutions claims:
Then another paradox is the Israelis:
Israel has one of the highest dietary polyunsaturated fats/saturated fat ratios in the world, their consumption of Omega – 6 polyunsaturated fats is about 8% higher than in the USA, and 10-12 % higher than in most European countries. Despite their “good diet” they have a high prevalence of cardiovascular diseases, hypertension, non insulin dependent diabetes and obesity.
In 2006 Womens Health Intervention USA:
48,835 women aged 50 to 79
Study length 8.1 years
Major intervention in diet – randomized interventional controlled clinical study – cannot get much more fair than this
Those randomized to the intervention group were intensively counseled to reduce their daily fat intake to 20% of calories, to increase their intake of fruits and vegetables to at least 5 servings daily and to increase grain consumption to at least 6 servings a day. The control group were consuming on average 37% calories of fat compared to the the intervention group’s 27%
Findings
Among the study population as a whole there were no significant differences in coronary heart disease, stroke incidence, CHD mortality or stroke mortality or total mortality.
Another paradox:
Changes in the Japanese Diet 1958 – 99
| 1958 | 1999 | |
| Total Calories | 2837 | 2202 |
| Carb intake % calories | 84 | 62 |
| Protein Intake % calories | 11 | 18 |
| Fat intake % calories | 5 | 20 |
| Cholesterol levels | 3.9mmol/l | 4.9 mmol/l |
| Rate of stroke aged 60-69 | 1334/100,000 per year | 226/ 100,000/year |
Going back to the NHS website: Evidence strongly indicates that high cholesterol levels can cause narrowing of the arteries (atherosclerosis), heart attack and stroke.
In this Japanese study, both rates of heart disease and stroke were reduced by an increase in saturated fat consumption and the increase in cholesterol levels.
Going back to the Framingham study,
A key finding was as follows:
There is a direct association between falling cholesterol levels over the first 14 years of the study and mortality over the following 18 years – 14% CVD death rate increase per 1mg/dl per year drop in cholesterol levels.
A mathematical translation of these findings shows that a 1mmol/L fall in cholesterol levels is equal to a 546% increase in risk of dying from cardiovascular disease.
Let have a look at Women and heart disease:
Women suffer much less than men with heart disease. They also have higher cholesterol levels than men.
Please explain this.
The Prosecution:
Women produce hormones that must protect themselves against heart disease
The Defense:
In 1963 a study was carried out on women who had hysterectomies. Half of the women had their ovaries removed at the same time so had no sex hormones and half retained their ovaries.
The results: There was no difference in the prevalence of coronary heart disease between the two groups. This suggests that there is no link between female hormones and their potential protective effect on the heart.
Additionally there is no record ever of any study proving that female hormones protect against heart disease. This seems to be just another ad hoc idea to back up the claim that high cholesterol causes heart disease.
In fact HRT (hormone replacement therapy) has been proven to increase the rate of heart disease.
It is also suggested that female hormones increases the HDL (good cholesterol) level and so this has a protective effect. Could you please explain how HDL actually removes cholesterol from the plaques?
The Prosecution:
HDL is part of the reverse cholesterol transport system, so it must take away the cholesterol from the plaques.
The Defense:
But artherosclertic plaques are covered by a lining that seperates the plaque from the blood stream. This cap is impermeable to HDL. A great deal of this cholesterol is in clefts, even crystals this is how Virchow recognized it 150 years ago. How can HDL extract this crystalised cholesterol?
There actually is no proven mechanism for this action.
To further stick a spanner into this good cholesterol, bad cholesterol theory, here are some more results from studies
In Poland, the men have high HDL levels and a high rate of heart disease
In Russia, there is found to be no relationship between level of HDL and mortality in women
If women are supposed to be protected against a high cholesterol level, how is it that there are countries where the women have lower cholesterol levels than men, but yet suffer more heart disease?
| Russian Women | British Men | |
| Rate of smoking | 10% | 27% |
| Average cholesterol | 5.4mmol/l | 6.0mmol/l |
| Average systolic BP | 132 | 134 |
| Saturated Fat consumption | 8.2% of calories | 13.6% of calories |
| Death rate from heart disease | 267/100,000 a year | 229/100,000 a year |
Russian women have a higher chance of dying from heart disease than british men, even though the men have far higher risk factors than the women.
This is also the case when you compare British women against French men. The women have a higher change of dying from heart disease.
Lets now take a look at the case of Australian Aboriginal Men:
| Aboriginal Men | British Men | |
| Average blood cholesterol | 4.9 mmol/L | 6.1 mmol/L |
| Average systolic BP | 125/77 | 133 |
| Average BMI | 23.2 | 25 |
| Average HDL | 1.1mmol/l | 1.3mmol/L |
| Death rate from heart disease | 1100/100,000 per year | 229/100,000 a year |
Lets take a look at Emigrant Asians who have some of the worst incidences of heart disease and stroke in the UK and USA
They also have far fewer risk factors too compared to the non asians, they smoke less, have lower LDL levels, have lower blood pressure and slightly less obese.
This is also the case for Native Americans who have severely high rates of heart disease.
A study in Russia in response to the dramatic increase in deaths due to heart disease in the latter half of the 20th century by Shetov showed that a low level of LDL was the most important risk factor for dying of heart disease.
Another study published in the Journal of the American Geriatric Society, 1991
Elevated total cholesterol was not found to be associated with CHD mortality in older men
Another study by National Center for Health Statistics:
Data for 2388 white persons aged 65-74 were examined to determine the relationship of serum cholesterol level to coronary heart disease incidence, there was no relationship between serum cholesterol level and coronary heart disease risk in men or women.
So how is it that high cholesterol is a problem if you are young, but once u get past a certain age it doesn’t matter, even though this is the age that you are most likely to die from heart disease?
The Prosecution:
Statins have shown that by lowering cholesterol levels you reduce the incidence of heart disease
The Defence:
Objection, could you please provide some strong evidence for this claim.
This is where it gets quite sinister. (I cannot believe that so many doctors are out prescribing this so called wonder drugs without looking at the evidence to support them.)
The Prosecution:
A couple of years ago a major trial that was supposed to last 5 years called ASCOTT-LLA was stopped early. The reason for this is because of the massive reduction in cardiovascular deaths in those given statins compared to those taking placebo. The drug under trial was Lipitor (atorvastatin). It was deemed that Atorvastatin was so powerful at reducing the risk of death that it was unethical to for it to not go on the market immediately.
The Defense:
Objection!
If you look closely at this trial in detail. The most important statistic was not talked about, the overall mortality rate, as in the total number of deaths from any cause. This however when charted shows no statistical significance between placebo and the drug. So although people are perhaps not dying as a result of cardiovascular reasons, they are dying as a result of something else instead.
The Prosecution:
A study in 2008 showed that treatment with rosuvastatin (Crestor) at a dose of 20 mg per day almost halved the risk of ‘vascular events’ (such as heart attack, stroke, and death from these conditions) in middle-aged and elderly men and women. Overall risk of death was down too in those taking the rosuvastatin, to the tune of 20 per cent. Average length of treatment was a shade under two years.
The Defense:
Objection!
These results look impressive but what is not being disclosed is some important facts about the study. The participants picked for the study were essentially healthy, and so their risk of things like heart attacks and strokes are pretty small. The risk of vascular events were 2.2% in the group taking the statin and 2.8 percent in the placebo group. So the absolute risk reduction as opposed to the relative risk reduction was only 0.5%. You can work this out by the difference of 0.6 / 2.8 x 100 = 20%. Now 20% sounds much more exciting than a mere 0.6% reduction.
What also is worth mentioning is that those who were treated with the Rosuvastatin had a significantly increased risk of developing diabetes.
The Prosecution:
Objection!
The authors of the study say that the increase in risk is due to chance and not due to the statin.
The Defense:
In that context could the so called 20% reduction in cardiovascular disease risk be due to chance too? Why is the benefits of statin not attributed to chance in the same way that its negative effects are?
Lets look even closer at the study which aims to prove that high cholesterol causes heart disease, as Rosuvastatin reduces blood cholesterol and so must reduce heart disease too.
You see this study was done in individuals whose cholesterol levels were not deemed to be risky. Individuals had to have LDL cholesterol levels of less than 130 mg/L (3.37 mmol/L) to qualify. However, to qualify for the study individuals did have to have elevated levels of a substance known as C-reactive protein (CRP). CRP is a marker for inflammation in the body, and inflammation is believed to be a key underlying process in the development of cardiovascular conditions such as heart disease and stroke.
Significant benefits were seen individuals who had elevated CRP levels, but no other major risk factors for cardiovascular disease (and LDL cholesterol levels of 100 mg/L or less). This inevitably throws up the possibility that in this study, the benefits of rosuvastatin came, at least in part, through its ability to reduce CRP levels. CRP levels actually dropped by 37 per cent on average in this study.
Cholesterol levels dropped too (LDL levels actually halved), but as the authors point out, the clinical benefit associated with this was much larger than expected. This finding also adds weight to the idea that rosuvastatin’s benefits may have been less to do with bringing cholesterol levels down, and more to do with an anti-inflammatory and/or other actions.
Lets have a look at some other cholesterol lowering drugs:
The Defense:
A review from 2005 assessing the impact of cholesterol reducing therapy on overall mortality. Here are the results:
Statins – statistically significant reduction in risk of overall mortality
Fibrates – NO statistically significant reduction in risk of overall mortality
Resins – NO statistically significant reduction in risk of overall mortality
Niacin – NO statistically significant reduction in risk of overall mortality
Diet – NO statistically significant reduction in risk of overall mortality
Could it be that statins reduce risk of heart disease by some other mechanism that has nothing to do with cholesterol at all?
Another study worth mentioning is one done by the University of British Columbia which is part of the worldwide Cochrane collaboration. They are totally independent organization that analyses health care interventions around the world. They decided to look at the use of statins in primary prevention, meaning people who do not have preexisting heart disease.
The results are :
If cardiovascular serious adverse events are viewed in isolation, 71 primary prevention patients with cardiovascular risk factors have to be treated with a statin for 3-5 years to prevent one myocardial infarction or stroke.
This cardiovascular benefit is not reflected in two measures of overall health impact, total mortality and total serious adverse events. Therefore statins have not been shown to provide an overall health benefit in primary prevention trials.
Dr Graham Jackson, in the UK looked at all the statin trials done up to year 2000. His conclusion published in the British Journal of Pharmacology was:
Longterm use of statins for primary prevention of heart disease produced a 1% greater risk of death over 10 years vs placebo when the result of all the big controlled trials reported before 2000 were combined.
I would now like to discuss whether statins actually improve the quality of lives? There is a huge push to get almost everyone statinated, with even statins being able to be bought over the counter in pharmacies. Do the public really know the risks of the many side effects?
Cholesterol as we know is one of the most abundant molecules in the body. It makes up around 60% of the brain. You will find that the synapses of the brain are nearly 100% cholesterol.
Could the crazy drive to lower cholesterol with Statins which by now should be quite clear, does not prevent heart disease in those who have had not yet had a heart attack or stroke, be the very reason for its long list of side effects, such as memory loss, muscle pain and cramps, tiredness and even death?
In addition to this, the Royal College of Psychiatry published a paper looking at the role of cholesterol in depression and self harm. It was titled, “Low cholesterol may indicate risk of suicide”
“Lower cholesterol levels were related to higher levels of self reported impulsivity. The finding of a lower average cholesterol in the Depression and Self harm group confirms other published studies”
“It is thought that cholesterol may influence serotonin, a neurotransmitter in the brain, low levels of which are associated not only with depression and suicide, but also aggression and impulsivity.”
Could the low cholesterol levels of Australian Aboriginal Men compared to British men indicate that they are just more depressed? After all they have been subjected to some of the worst social dislocation of any group.
Could this stress and depression actually be what causes their exceptionally high levels on heart disease?
Statins also dramatically lowers the body’s natural production of Co Q 10 as its biochemical pathway is similar to cholesterol in the liver. Lets take a look at its magnificent functions for our body.
Co-enzyme Q10 is needed for the following life giving functions:
- It is a naturally occurring fat-soluble antioxidant
- It is necessary to the functioning of every cell in our bodies.
- It is produced in the body and found throughout nature in plants and animals.
- Our bodies could not survive without it. If body levels start dropping, so does our general health.
- Low levels can result in high blood pressure, heart attack, angina, immune system depression, periodontal disease, lack of energy and obesity.
- As more energy is required, the more CO-Q-10 is needed in the diet, especially in the heart and other tissues that require lots of energy.
Why is it that so few G.Ps prescribe a supplement of this along side statins? Why is it not an essential requirement for Statins pills to be combined with Co enzyme q10?
Why is it also that there is such as strong association between big drug companies and research into heart disease?
Calling Dr Marcia Angell, New England Journal Of Medicine (one of the most influential journals)
“It used to be that drug companies simply gave grants to academic medical centeres for the use of their clinical researcher to do a study and that was it. It was at arms length. Now it is very different, the drug companies increasingly design the studies. They keep the data. They don’t even let the researchers see the data at the end of it. They sign contracts with the researchers and with academic medical centers saying that they don’t get to publish their work unless they get permission from the drug company”
An Article published in the New York Times, 2009
In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.
Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.
The Judge:
I would like both sides to summarise their evidence for the Jury to decide their verdict. Does high cholesterol cause heart disease or is it something else?
The Prosecution:
1. Countries with high saturated fat consumption have higher cholesterol levels and high death rates from heart disease., Ancel Keys
2. People with high cholesterol in the blood have high rates of heart disease, Framingham study and familial hypercholesterolaemia
3. Rationing in WW11 was followed by a fall in heart disease rates
4. Plaques in the arteries are full of cholesterol, Virchow, Anitschkov
5. Rabbits fed on high fat diets develop high cholesterol levels and heart disease
6. Lowering blood cholesterol levels with statins reduces the rate of heart disease
The Defense:
1. There is no association between average cholesterol levels, saturated fat consumption and the heart disease rate between countries, 14 country study, Dr Kendrick and many paradoxes found in countries such as Sweden, France
2. Over the age of 50 the relationship between heart disease and cholesterol levels is gone, National center for health statistics
3. A falling cholesterol level is associated with a greater risk of heart disease, emigrant asian indians.
4. When closely examining statin trials you can clearly see that statins offer no benefit to those who do not have heart disease, but show some benefit to those who have already got heart disease in preventing heart attacks. The actual risk reductions have been spiced up with clever statistical adjustments and there is also a very strong link between drug companies and the research into statin development indicating many results of trials could be misleading, unaccurate and biased with dangerous consequences to the public
5. There is no explanation for the mechanism by which “good” cholesterol actually mops up excess cholesterol in the arteries. There is no clear explanation for the actual role “bad” cholesterol plays in forming atherosclerotic plaques. People get heart disease even with low levels of LDL, Australian Aborigenes.
6. The fact that cholesterol serves such a vital role in the body could explain why many people are shown to be protected by a higher cholesterol level after a certain age, as it is likely to be involved in the healing process when injury occurs in the coronary artery due to many other risk factors. But very low cholesterol levels are associated with an increased risk of many other diseases such as depression, cancer and stroke. Not to mention the recent increases in diseases of the brain where cholesterol is found in the highest levels, such as Alzeimers and Dementia.
7. It seems that high cholesterol does not in fact cause heart disease, it is something entirely different. In young men, a high cholesterol level could be an indicator that something is going wrong, rather than the actual cause. It seems whenever this idea that high cholesterol causes heart diseaese, as it is still just an idea, is questioned with strong evidence to suggest otherwise, more and more ad-hoc theories are added on, when it would probably be easier and healthier or everyone to just admit that high cholesterol does not cause heart disease, it is something else entirely.
“So now Jury, its time for you to decide, does cholesterol causes heart disease, or could it be something else?”
I hope this has helped you to understand more clearly the various cholesterol myths so you can make a more fair judgment based on the evidence provided. Please do not take my word as gospel, go and do your own research first and draw your own conclusions.
Niraj Naik MPharm