Does Cholesterol Cause Heart Disease?

By Dr Harold Gunatillake Health Writer FRCS, FACS (US), FIACS (US), AM (SING), MBBS (Cey)

This is a million dollar question. The common belief for many years propagated and promoted by statin manufacturing American companies is now being disputed by some sections of the medical fraternity.

They believe that Heart Disease is not caused by cholesterol and probably the root cause is low HDL-cholesterol (good cholesterol), and too many free radicals in the blood stream. It is believed that LDL-cholesterol (bad fellow), the major component of the cholesterol circulating in the blood stream is as innocent and beneficial to the wellbeing as HDL-cholesterol. LDL-cholesterol prevents infections in the blood stream and by itself is an anti-oxidant. It is believed that this innocent LDL-cholesterol is attacked by free radicals to make them bad. We also refer to this bad cholesterol as 'oxidized LDL cholesterol'.

HDL-cholesterol then has the responsibility of removing this oxidized form of LDL-cholesterol to cause no further damage. HDL-cholesterol is also supposed to remove plaque buildup from the lining of artery walls. It is this buildup of plaques that causes hardening (atherosclerosis) of arteries responsible for narrowing of coronary vessels and heart disease.

The root cause of heart disease is a diet nutritionally insufficient to maintain healthy HDL level and nutritionally insufficient to offset the numerous sources of free radicals, including the natural free radicals in fresh air, excess free radicals in air pollution, natural free radicals created during cellular processing of protein, fat, and carbohydrates (eating too much). Trans-fat in the diet lowers HDL. So beware of the frozen foods and refined foods with trans-fats added to increase the shelf life of the food items.

The same cholesterol – LDL and HDL travel through the veins also, but they do not seem to create buildup of plaques in the veins. So why blame cholesterol for plaque buildup in arteries?

Statins should not be used to bring down the cholesterol level in the blood, after the age of 70. Studies done on old people in nursing homes, where statins were given to half the population having high cholesterol, and the other half no statins were given, though the cholesterol level was as high. At the end of a 10 year period, it was revealed that the latter group given no statins lived much longer than the other batch given statins for high cholesterol levels.

This is an eye opener to all of us, to know that one should forget worrying about high cholesterol levels after the age of 70, unless you suffer from heart disease. In such a situation the statin medication is required presumably to prevent a heart attack (not heart disease).

According to the findings of Uffe Ravnskov, MD, PhD, people with high cholesterol live the longest. This emerges clearly from many scientific papers.

Consider the finding of Dr Harlan Krumholz of the Department of Cardiovascular Medicine at Yale University, who reported in 1994 that old people with low cholesterol died twice as often from a heart attack as did old people with a high cholesterol. High cholesterol in old people is not a risk factor especially for women.

I knew an elderly lady patient of mine who was concerned about high cholesterol in her blood, and she was quite healthy and independent at the age of 90 years. My repeated advice to her was eat well and be happy. She lived happily till 96 years, and did not die of a vascular disease.

Most studies have found that for women, high cholesterol is not a risk factor for heart disease at all – in fact the death rate for women is five times higher in those with very low cholesterol.

In a Canadian study that followed 5,000 healthy middle-aged men for 12 years, they found that high cholesterol was not associated with heart disease at all. And in another study done at the University Hospital in Toronto that looked at cholesterol levels in 120 men that previously had heart attacks, they found that just as many men that had second heart attacks had low cholesterol levels as those that had high.

The Maoris of New Zealand die of heart attacks frequently, irrespective of their cholesterol levels. In Russia, it is low cholesterol levels that are associated with increased heart disease. The Japanese are often cited as an example of a population that eat very little cholesterol and have a very low risk of heart disease. But the Japanese that moved to the US and continued to eat the traditional Japanese diet had heart disease twice as often as those that maintained the Japanese traditions but ate the fatty American diet.

This suggests that it is something else, like stress perhaps, that is causing the heart disease.

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