For decades we have been told that so-called bad LDL cholesterol will clog our arteries and cause heart attacks and premature death. That is why statin-type cholesterol-lowering drugs have been prescribed to tens of millions of people. What if the science is not as iron-clad as most health professionals assume?
Polarization in Politics and Medicine:
People have come to expect politics to be polarized. Neither side seems willing to compromise or even consider a competing perspective.
Although this has become the norm for politicians, we don’t expect such conflict from physicians and researchers. Over the last several months, however, we have seen bitter discord among doctors. They are fighting about the fundamental causes and prevention of heart disease.
The Cholesterol Skeptics:
The most recent controversy erupted when a group of cholesterol skeptics published a meta-analysis in the journal BMJ Open (June 12, 2016). They acknowledged that:
“For decades, the mainstream view has been that an elevated level of total cholesterol is a primary cause of atherosclerosis and cardiovascular disease.”
Their analysis of 19 studies covering 68,094 people over 60 years of age found, on the contrary, that elderly people with high LDL cholesterol live as long or longer than those with low LDL cholesterol.
Needless to say, this finding that elevated levels of bad LDL cholesterol appear to be protective rather than risky in older people was greeted with suspicion and derision. Cardiologists characterized the study as “deeply flawed” and “disappointingly unbalanced.” A physician at Johns Hopkins, Michael Blaha, MD, MPH, characterized its conclusions as “completely unwarranted.”
The Ultimate Statin Sin:
The worst “sin” committed by the authors of the study was questioning the value of certain medications: “the benefits from statin treatment have been exaggerated.” They expressed the opinion that treating elderly people with statins to reduce their cholesterol is a waste of time and resources.
Challenging the value of cholesterol-lowering statin treatment is a little like criticizing the cherished American values of motherhood and apple pie. This is especially true when it comes to older people. After all, the American Heart Association and the American College of Cardiology have established recommendations that virtually every man over the age of 60 should be on a statin-type drug. (For women, the cut-off is closer to 70.)
The Honolulu Heart Program Disappeared Without a Trace:
Despite the skepticism with which this new study has been greeted, it is not the first to question the primacy of cholesterol in heart disease. The Kuakini Honolulu Heart Program started in 1965 and studied coronary heart disease and stroke in 8,000 Japanese-American men. The researchers have generated hundreds of papers, but one published in The Lancet (Aug. 4, 2001) showed that men with low cholesterol concentrations were more likely to die early than those with the higher cholesterol levels. The scientists remarked, “These data cast doubt on the scientific justification for lowering cholesterol to very low levels in elderly people.”
Many doctors have come to believe that every older person they see deserves a statin, regardless of their lifestyle or overall health. Runners, swimmers, vegetarians or vegans, all are handed a prescription whether or not their so-called bad LDL cholesterol is elevated or their blood sugar is out of control. This puts patients in a terrible bind. Whom should they trust-their personal doctor or the latest research?
Are You Frustrated with the Feuding Physicians?
Americans seem to be fed up with feuding politicians. We doubt they appreciate such behavior in their physicians, either. Instead, it makes sense for doctors to examine the evidence and then make individualized recommendations for each patient.
We have been chastised by physicians who cannot understand why anyone would question the cholesterol hypothesis. They treat virtually all their older patients with statins because the American Heart Association tells them that is good medical practice. If someone shows up with a bad LDL cholesterol level over 100 they increase the dose of statin regardless of side effects. The health professionals feel frustrated when their wisdom is challenged by the research described above.
To help you sort through the conflicting data on salt, saturated fat, LDL cholesterol and statins, we offer you an in-depth analysis of the most recent data at this link. We understand that the pillars of heart healthy advice are crumbling:
- Avoid extra salt
- Curtail fat intake, especially saturated fat
- Eat high-carb food (the old food pyramid)
- Lower LDL cholesterol below 100 or better yet below 70
There are still die-hards who give up their beliefs begrudgingly. They are still promoting sodium intake below 1500 mg daily and think a low-fat diet will prevent heart disease. The American Heart Association is circling the wagons and the American Diabetes Association still thinks a high-carb, low-fat diet is healthy. The data continue to accumulate, though, and the “experts” will eventually have to consider the science more objectively. We suspect that their patients will be way ahead of them.
Please comment below on this controversial topic and vote at the top of the page. Share your own story as well.
