Does high cholesterol cause heart disease?

The standard belief around cholesterol is that it is ‘bad’ and causes heart disease. However according to newer research, inflamation may actually be the main driver of heart disease.

An article in Nature, 6/9/2021, Inflamation in heart disease, reviews research done by Paul Ridker that questions cholesterol as the driving cause. His theory was so radical at the time, in the 1990’s, that he couldn’t find funding, so he found ways to collect the data without funding, and what he found was groundbreaking.

Middle age men with high levels of an inflammatory marker, called C reactive protein, were at increased risk of heart disease, regardless of cholesterol. This research has changed the way we currently think of heart disease, and led to an understanding that cholesterol is only part of a much more complicated picture. In fact 50% of heart attacks and strokes occur in people who have normal levels of cholesterol.

Ridker carried out a landmark trial to test his new theory. It was called the Jupiter trial, Justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin. In it they recruited 18,000 people with low cholesterol and high CRP levels. they gave half of the participants a statin drug which is a common cholesterol lowering drug, and half a placebo. Those who took the medication saw a 44% reduction in their risk for heart disease, suggesting statins may actually reduce inflammation and the lipid lowering effects may be secondary. Since this study medicine has explored many more drugs to reduce inflammation, measuring heart disease as an endpoint to measure. colchicine is one of the drugs emerging as an inexpensive, relatively safe therapeutic that is gaining traction.

So what does this mean for me?

Well, as all things in medicine, it’s complicated, but it is creating a picture that encourages widening the lens when looking at prevention of heart and vascular disease. If half of all people who have heart disease have normal cholesterol levels, maybe we don’t need to focus so much on total cholesterol levels, when determining risk.

65% of people who suffer from heart attacks, are diabetic.

Our current cholesterol testing is antiquated. While a useful screening tool, it is very limited in determining the size of the particles, which is more important than the total weight. Ask your provider to order the NMR lipid protein profile from labcorp, or the Cardio IQ from Quest labs. Which will be more specific and give you a better idea of your risk.

New research suggests that inflamation and oxidative stress may be the most important risk factor for heart disease. We can order tests to evaluate this, but one of the easiest, is to look at your midsection. Do you have fat around your belly? This is one of the easiest indicators to evaluate risk without lab testing. This same belly fat, creates cytokines, inflammatory protein changes the cholesterol by oxidizing it. Once oxidized, the cholesterol becomes sticky and clings to the walls of the arteries creating plaques.

Diet and exercise may be the best tool we have to combat heart disease.

Medication comes a close second.

Start with small changes. increase your healthy fats by substituting fish for a burger. park further away from the grocery store and walk a little bit further to get to your car. walk to the mail box instead of driving to it. Stop drinking sodas and sugary beverages. Make sure that you are getting regular check ups, and ask your provider to do more specialized lipid testing, especially if you have early history of heart disease in your family.