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Cholesterol May Not Be Cause of CVD

Cholesterol May Not Be Cause of CVD

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Published by: Lis4cg on Apr 01, 2010
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Rick Weinstein <rick.weinstein@gmail.com>
cholesterol may not be cause of CVD
Ed Bauman <edb@baumancollege.org>Thu, Mar 18, 2010 at 9:14 AM
To: Rick Weinstein <rick.weinstein@gmail.com>Rick, please share with any of our E4HF guest who might be interested. Thanks, Ed
Why Cholesterol May Not Be the Cause of Cardiovascular Disease
Mark Hyman, MD
We have all been led to believe that cholesterol is bad and that lowering it is good. Because of extensive pharmaceuticalmarketing to both doctors and patients we think that using statin drugs is proven to work to lower the risk of heart attacks anddeath.But on what scientific evidence is this based, what does that evidence really show?Roger Williams once said something that is very applicable to how we commonly view the benefits of statins. "There are liars,damn liars, and statisticians."We see prominent ads on television and in medical journals -- things like 36% reduction in risk of having a heart attack. But wedon't look at the fine print. What does that REALLY mean and how does it affect decisions about who should really be usingthese drugs.Before I explain that, here are some thought provoking findings to ponder.• If you lower bad cholesterol (LDL) but have a low HDL (good cholesterol) there is no benefit to statins. (i)• If you lower bad cholesterol (LDL) but don't reduce inflammation (marked by a test called C-reactive protein), there is nobenefit to statins. (ii)• If you are a healthy woman with high cholesterol, there is no proof that taking statins reduces your risk of heart attack ordeath. (iii)• If you are a man or a woman over 69 years old with high cholesterol, there is no proof that taking statins reduces yourrisk of heart attack or death. (iv)• Aggressive cholesterol treatment with two medications (Zocor and Zetia) lowered cholesterol much more than one drugalone, but led to more plaque build up in the arties and no fewer heart attacks. (v)• 75% of people who have heart attacks have normal cholesterol• Older patients with lower cholesterol have higher risks of death than those with higher cholesterol. (vi)• Countries with higher average cholesterol than Americans such as the Swiss or Spanish have less heart disease.• Recent evidence shows that it is likely statins' ability to lower inflammation it what accounts for the benefits of statins,not their ability to lower cholesterol.So for whom do the statin drugs work for anyway? They work for people who have already had heart attacks to prevent more heartattacks or death. And they work slightly for middle-aged men who have many risk factors for heart disease like high bloodpressure, obesity, or diabetes.So why did the 2004 National Cholesterol Education Program guidelines expand the previous guidelines to recommend that morepeople take statins (from 13 million to 40 million) and that people who don't have heart disease should take them to prevent heartdisease. Could it have been that 8 of the 9 experts on the panel who developed these guidelines had financial ties to the drugindustry? Thirty-four other non-industry affiliated experts sent a petition to protest the recommendations to the National Institutesof Health saying the evidence was weak. It was like having a fox guard the chicken coop.It's all in the spin. The spin of the statistics and numbers. And it's easy to get confused. Let me try to clear things up.When you look under the hood of the research data you find that the touted "36% reduction" means a reduction of the number ofpeople getting heart attacks or death from 3% to 2% (or about 30-40%).
3/18/2010Gmail - cholesterol may not be cause ohttps://mail.google.com/mail/?ui=2&ik1/5
And that data also shows that treatment only really works if you have heart disease already. In those who DON'T havedocumented heart disease, there is no benefit.In those at high risk for heart disease about 50 people would need to be treated for 5 years to reduce one cardiovascular event.Just to put that in perspective: If a drug works, it has a very low NTT (number needed to treat). For example, if you have a urineinfection and take an antibiotic, you will get near a 100% benefit. The number needed to treat is "1". So if you have an NTT of 50like statins do for preventing heart disease in 75% of the people who take them, it is basically a crap shoot.Yet at a cost of over $28 billion a year, 75% of all statin prescriptions are for exactly this type of unproven primary prevention.Simply applying the science over 10 years would save over $200 billion. This is just one example of reimbursed but unprovencare. We need not only prevent disease but also prevent the wrong type of care.If these medications were without side effects, then you may be able to justify the risk - but they cause muscle damage, sexualdysfunction, liver and nerve damag,e and other problems in 10-15% of patients who take them. Certainly not a free ride.So if lowering cholesterol is not the great panacea that we thought, how do we treat heart disease, and how do we get the rightkind of cholesterol - high HDL, low LDL and low triglycerides and have cholesterol particles that are large, light and fluffy ratherthan small, dense and hard, which is the type that actually causes heart disease and plaque build up.We know what causes the damaging small cholesterol particles. And it isn't fat in the diet. It is sugar. Sugar in any form orrefined carbohydrates (white food) drives the good cholesterol down, cause triglycerides to go up, creates small damagingcholesterol particles, and causes metabolic syndrome or pre-diabetes. That is the true cause of most heart attacks, NOT LDLcholesterol.One of the reasons we don't hear about this is because there is no good drug to raise HDL. Statin drugs lower LDL -- and billionsare spent advertising them, even though they are the wrong treatment.If you're like most of the patients I see in my practice, you're convinced that cholesterol is the evil that causes heart disease. Youmay hope that if you monitor your cholesterol levels and avoid the foods that are purported to raise cholesterol, you'll be safe fromAmerica's number-one killer.We are all terrified of cholesterol because for years well-meaning doctors, echoed by the media, have emphasized what they longbelieved is the intimate link between cholesterol and death by heart disease. If only it were so simple!The truth is much more complex.Cholesterol is only one factor of many -- and not even the most important -- that contribute to your risk of getting heart disease.First of all, let's take a look at what cholesterol actually is. It's a fatty substance produced by the liver that is used to help performthousands of bodily functions. The body uses it to help build your cell membranes, the covering of your nerve sheaths, and muchof yourbrain. It's a key building block for ourhormone production, and without it you would not be able to maintain adequate levels of testosterone, estrogen, progesterone and cortisol.So if you think cholesterol is the enemy, think again. Without cholesterol, you would die.In fact, people with the lowest cholesterol as they age are at highest risk of death. Under certain circumstances, highercholesterol can actually help to increase life span.To help clear the confusion, I will review many of the cholesterol myths our culture labors under and explain what the real factorsare that lead to cardiovascular disease.
Cholesterol Myths
One of the biggest cholesterol myths out there has to do with dietary fat. Although most of us have been taught that a high-fatdiet causes cholesterol problems, this isn't entirely true. Here's why: The type of fat that you eat is more important than theamount of fat. Trans fats or hydrogenated fats and saturated fats promote abnormal cholesterol, whereas omega-3 fats andmonounsaturated fats actually improve the type and quantity of the cholesterol your body produces.In reality, the biggest source of abnormal cholesterol is not fat at all -- it's sugar. The sugar you consume converts to fat in yourbody. And the worst culprit of all is high fructose corn syrup.Consumption of high fructose corn syrup, which is present in sodas, many juices, and most processed foods, is the primarynutritional cause of most of the cholesterol issues we doctors see in our patients.So the real concern isn't the amount of cholesterol you have, but the type of fats and sugar and refined carbohydrates in your dietthat lead to abnormal cholesterol production.Of course, many health-conscious people today know that total cholesterol is not as critical as the following:
3/18/2010Gmail - cholesterol may not be cause ohttps://mail.google.com/mail/?ui=2&ik2/5
• Your levels of HDL "good" cholesterol vs. LDL "bad" cholesterol• Your triglyceride levels• Your ratio of triglycerides to HDL• Your ratio of total cholesterol to HDLMany are also aware that there are different sizes of cholesterol particles. There are small and large particles of LDL, HDL, andtriglycerides. The most dangerous are the small, dense particles that act like BB pellets, easily penetrating your arteries. Large,fluffy cholesterol particles are practically harmless--even if your total cholesterol is high. They function like beach balls andbounce off the arteries, causing no harm.Another concern is whether or not your cholesterol is rancid. If so, the risk of arterial plaque is real.Rancid or oxidized cholesterol results fromoxidative stressand free radicals, which trigger a vicious cycle ofinflammationand fator plaque deposition under the artery walls. That is the real danger: When small dense LDL particles are oxidized they becomedangerous and start the build up of plaque or cholesterol deposits in your arteries.Now that we've explored when and how cholesterol becomes more problematic, let's take a look at other factors that play a moresignificant role in cardiovascular disease.
Prime Contributors to Cardiovascular Disease
First of all, cardiovascular illness results when key bodily functions go awry, causinginflammation, (vii) imbalances in blood sugar and insulin andoxidative stress.To control these key biological functions and keep them in balance, you need to look at your overall health as well as yourgenetic predispositions, as these underlie the types of diseases you're most likely to develop. It is the interaction of your genes,lifestyle, and environment that ultimately determines your risks -- and the outcome of your life.This is the science ofnutrigenomics, or how food acts as information to stall or totally prevent some predisposed disease risksby turning on the right gene messages with our diet and lifestyle choices. That means some of the factors that unbalance bodilyhealth are under your control, or could be.These includediet,nutritional status, stress levels, and activity levels. Key tests can reveal problems with a person'sblood sugar and insulin,inflammation level, level offolic acid, clotting factors,hormones, and other bodily systems that affect your risk of cardiovascular disease.Particularly important are the causes ifinflammation, which are many, and need to be assessed. Inflammation can arise frompoor diet(too much sugar and trans and saturated fats), a sedentary lifestyle,stress,autoimmune disease,food allergies, hidden infections such as gum disease, and eventoxins such as mercury. All of these causal factors need to be considered anytimethere is inflammation.Combined together, all of these factors determine your risk of heart disease. And I recommend that people undergo acomprehensive medical evaluation to see what their risk really is.
Zeroing in on Key Factors for Heart Disease
There's no doubt about it,inflammationis key contributor to heart disease. A major study done at Harvard found that people withhigh levels of a marker calledC-reactive protein(CRP) had higher risks of heart disease than people with high cholesterol. Normalcholesterol levels were NOT protective to those with high CRP. The risks were greatest for those with high levels of both CRP andcholesterol.Another predisposing factor to heart disease isinsulin resistanceormetabolic syndrome, which leads to an imbalance in the blood sugar and high levels of insulin. This may affect as many as half of Americans over age 65. Many younger people also havethis condition, which is sometimes calledpre-diabetes.Although modern medicine sometimes loses sight of the interconnectedness of all our bodily systems, blood sugar imbalanceslike these impact your cholesterol levels too. If you have any of these conditions, they will cause your good cholesterol to godown, while your triglycerides rise, which further increasesinflammationandoxidative stress. All of these fluctuations contribute to blood thickening, clotting, and other malfunctions -- leading to cardiovascular disease.What's more, elevated levels of a substance calledhomocysteine(which is related to your body's levels of folic acid andvitamins B6 and B12) appears to correlate to cardiovascular illness. Although this is still somewhat controversial, I often see this inter-relationship in my practice. While genes may play a part, tests done as part of a comprehensive evaluation of cardiac risk caneasily ascertain this factor. Where problematic levels occur, they can be easily addressed by adequatefolic acidintake, alongwithvitamins B6 and B12.
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