Cholesterol Levels and Cardiovascular Disease

Despite the glowing reports statin drugs receive in the press for their risk reduction in stroke and heart attack, strong evidence exists that they do so independently of cholesterol manipulation despite the past 35 years of vilification of this substance.

Ravnskov summarizes that statin drug therapy is reported to be almost as effective for women as for men despite the fact that most studies have shown cholesterol not to be a significant risk factor for women. Additionally the elderly are protected just as much as younger individuals, although all studies have shown that cholesterol is only a weak risk factor, if at all, for men older than fifty.

Another result mitigating against a cholesterol explanation for statin effectiveness is the consistent observation that strokes are reduced after statin therapy even though high cholesterol is known as only a weak risk factor for stroke, if indeed it is a risk factor at all. Further burying a possible cholesterol effect mechanism for Statins is the fact that they protect regardless of whether the patient's cholesterol is high or low.

Clearly mechanisms other than cholesterol change must be invoked to explain statin drug effectiveness in strokes and heart attacks. Possibilities include such anti-inflammatory action as platelet inhibition and smooth muscle blockage but this paradoxical action of the statin drugs still remains to be explained.

Meanwhile the war against cholesterol continues unabated apparently oblivious to the fact that scientific justification for such steadfast focus has all but vanished.

As McCully has firmly established, homocysteine elevation and subtle vitamin deficiency states now are taking center stage as factors intrinsic to the development of arteriosclerosis. The role of cholesterol is now seen to be rather a passive one, dragged into a plaque only in its toxic, oxidized form quite alien to the natural substance making up so much of our brain.

More and more research results are accumulating that argue against the merits of excessively low cholesterol in the public at large. The lower the better for serum cholesterol no longer seems to be a valid statement.

Certainly this seems to be the case for the cognitive side effects, which Doctor Beatrice Golomb reports are far more common when cholesterol values plummet. Paul Rosch, well-known researcher and spokesman for the scientific community cites recent disquieting evidence from statin studies on animals that there is a carcinogenic consequence of artificially low cholesterol and a personal conviction that such findings may well become evident in humans after sufficient follow-up time.

We can be certain only that we do not yet know the long-term consequences of artificially lowered serum cholesterol through the use of statin drugs. In light of current evidence, for most of us, our present almost day-to-day preoccupation with serum cholesterol values appears misguided.

If cholesterol is our enemy, it is a strange enemy, indeed, for without abundant and immediate cholesterol reserves in our bodies, life is impossible. Our true enemy is arteriosclerosis, the product of other nutritional factors, hypertension, diabetes, smoking and increasing sedentary existence.

The end result of this process is plaque formation with inflammation, ulceration and thrombus formation. Cholesterol can be drawn passively into this process but even in the absence of cholesterol elevation, the process continues. C-reactive protein, the product of this inflammatory and ulcerative process, not cholesterol, now is recognized by many to be the most consistently accurate predictor of strokes and heart attacks to come.

Although this information is now common knowledge among those researchers in the field, the overwhelming majority of practicing physicians and lay public still regard cholesterol as public health enemy #1 - such is the effect of thirty-five years of a powerful but misdirected war against fat and cholesterol in our diet.

Truly, much work remains to be done in the field of public health education for cholesterol is not our enemy, it is our indispensable friend. Remember - you cannot live without it.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor


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