More recommendations come to cut our cholesterol to levels that may hasten our demise

You don’t have to wait too long before yet another study is published which is used to persuade us that cholesterol is a killer and cholesterol-reducing drugs are essential for keeping us from the mortal spectre of heart disease. The focus, for some time, has been on controlling so-called ‘low density lipoprotein (LDL) cholesterol’ ” the form of cholesterol we are told is responsible for gumming up our arteries and increasing risk of heart disease. Official recommendations regarding LDL levels come from a body known as the National Cholesterol Education Programme in the USA. The latest recommendations from this body emerged in 2004 when it advised that:

For patients at high risk of heart disease LDL should be lower than 2.59 mmol/l (100 mg/dL)

For patients at very high risk of heart disease LDL should be lower than 1.81 mmol/l (70 mg/dL)

The suggestion is that individuals whose cholesterol levels are above these thresholds should take enough statin (cholesterol reducing medication) to get them into the ‘desirable’ range.

However, not everyone agreed with these recommendations. The authors of an independent review of the basis for these recommendations which appeared in the Annals of Internal Medicine stated: In this review, we found no high-quality clinical evidence to support current treatment goals for [LDL] cholesterol. They also went on to say that the recommended practice of adjusting statin dose to achieve recommended cholesterol levels was not scientifically proven to be beneficial or safe [1]. After the guidelines were published it was subsequently revealed that of the 9 members of the NCEP panel, all but one of whom had potential financial conflicts of interest that you can read here. Also, see here for reasons why it might not be such a good idea to drive cholesterol levels too low (namely because low cholesterol levels are associated with an increased risk of cancer and, err, death).

You may need this background when you consider the conclusions drawn from a study published last week in the American Heart Journal [2]. In this study, cholesterol levels were measured in almost 137,000 individuals, soon after they had been admitted to hospital with a heart-disease related problem (e.g. heart attack). It was found that almost half (49.6 per cent, to be precise) of these individuals had LDL levels less than 2.59 mmol/l (100 mg/dl). And almost 18 per cent had cholesterol levels less than 1.81 mmol/l (70 mg/dL). The authors concluded that These findings may provide further support for recent guideline revisions with even lower LDL goals. This study is being used to suggest that the NCEP guidelines may simply not be low enough. See here for an example (originating from Reuters) of how this study is being reported.

Now, stepping aside from the science for just a moment, let’s view all of this from a common sense perspective. Cholesterol is a substance which, among other things, is essential for the production of steroid hormones in the body (e.g. cortisol and sex hormones). It also plays an essential role in the membranes of the body’s cells. Cholesterol is crucial to health. But the message appears to be that what are essentially ‘normal’ levels of cholesterol are somehow causing a disease i.e. heart disease. Some would say that the notion that an essentially body constituent at normal levels is putting us in mortal danger doesn’t really make sense.

But more importantly, perhaps, what of the science? Well, we’ve been here before: all this focus on heart disease neglects the fact that heart disease is not the only killer. Far better, I think, to focus on funeral rates (overall mortality, in medical parlance). And as stated above, here we see the idea of lowering cholesterol levels to death-defying levels might actually, ironically, be hastening individuals’ demise. More on the potential hazards of cholesterol reduction can be read here.

Read the Reuters report that I’ve linked to and you’ll see that one of the authors of this study, Dr Gregg Fonarow, has stated that: “The conventional cholesterol guidelines are missing the majority of patients” who have heart attacks and related problems. I feel it only fair to point out (unlike the Reuters piece) that Dr Fonarow does have some conflicts of interest to declare when it comes to receiving money from statin manufacturers. In the actual paper, these are listed as: research from Pfizer and GlaxoSmithKline; consultant and honorarium from Abbott, AstraZeneca, GlaxoSmithKline, Merck, Pfizer, and Schering Plough…”

Dr Fonarow and his co-authors clearly have a special interest in cholesterol and health, and so it seems a shame to me that at no point in their paper does the subject of cholesterol levels and its relationship to overall mortality or cancer come up. According to Dr Fonarow, the results of this study should serve as a wake-up call for anyone interested in reducing death and disability due to cardiovascular disease.” I say the evidence linking low cholesterol levels with an increased risk of death should serve as a wake-up call to Dr Fonarow and his co-authors.

References:

1. Hayward RA, et al. Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem. Ann Int Med 2006;145:520-530

2. Sachdeva A, et al. Lipid levels in patients hospitalized with coronary artery disease: An analysis of 136,905 hospitalizations in Get With The Guidelines. American Heart Journal.
2009;157(1) 111-117.

12 Responses to More recommendations come to cut our cholesterol to levels that may hasten our demise

  1. Ted Hutchinson 27 January 2009 at 5:39 pm #

    I think the dangers of Statin side effects are far greater than we currently realise. ,
    http://tinyurl.com/bvobrg,
    This Google Translate (Swedish, Lund University,
    Cholesterol essential for insulin secretion )
    news article discusses how lowering cell cholesterol levels reduces their capacity to make insulin and may lead to increasing diabetes incidence and possibly also adversely affect the prognosis for diabetics.

  2. David F 28 January 2009 at 3:43 am #

    About 3 or 4 months ago I stumbled across a one page “poster” which summarised the results of the study Dr Briffa refers to in this post. The link is here: http://astute.cardiosource.com/2007/vposters/pdf/275_Fonarow.pdf

    This one page confirmed to me how screwed the medical fraternity is on cholesterol and statins recommendations.

    Interesting to see the “Patient Chracteristics” Table:
    1. 32.1% of patients had diabetes
    2. 43.5% of patients had hyperlipidemia
    3. 32% had been smokers in the prior year.

    Why the intense focus on cholesterol?? Oh yeah, I know – $$$.

  3. Kristine Franklin-Ross 30 January 2009 at 1:13 pm #

    Interesting Ted, I thad a stroke in May last year and was put on the usual drugs, including simvastatin and something for my diabetes. I could not get my sugar level to stabilise at all and it ran high most of the time, despite eating a low carb diet. I stopped taking the statin after 3 months and have had perfect blood sugars ever since. These are evil drugs, I had awful side effects and it took a good 2 to 3 months to feel normal again.

  4. Hilda Glickman 30 January 2009 at 4:25 pm #

    Maybe we should be asking why cholesterol levels go up. It could be to help repair arteries damaged by free radicals or because the liver isn’t processing it properly.

  5. Jennifer Eloff 30 January 2009 at 6:35 pm #

    I think they are out to lunch in my humble opinion. Certainly, they are with regard to statins. I won’t take anything with such a bad track record.

    We know inflammation leads to heart disease. We know dentists have discovered that taking a tiny amount of doxycycline (no adverse gut problems reported but take yogurt or a probiotic to be on the safe side) daily reduces inflammation of gums, and they have since discovered after 6 months general inflammation markers (CRP levels) dropped by more than a half. I have the study somewhere if anyone is interested – I’m too lazy to go find it now.

    Inflammation leads to heart disease we’re told and a host of other diseases. I’m a lay person but my logic says: “Cut the inflammation and perhaps the body won’t have to try so hard to repair the arteries by laying down fatty deposits” I think we’re maybe blaming cholesterol, when, in fact, the real culprit is being overlooked.

  6. Jennifer Eloff 30 January 2009 at 6:36 pm #

    Okay, here is the study: http://www.natural-hrt.com/artman/publish/article_133.shtml

  7. Dr. Paul C. Murray, PhD Physics 31 January 2009 at 3:43 am #

    It is my understanding that levels of C-reactive protein more accurately predict heart attacks than chloresterol.

    Is anyone testing for C-reactive protein in order to prescribe sensible dosage of statins. I am assuming once a low reading of C-reactive protein is achieved, that is adequate regardless of the high or low LDL reading?

  8. Iain Dobson 31 January 2009 at 8:45 am #

    I would recommend reading “The Great Cholesterol Con” by Dr Malcolm Kendrick which Dr Briffa has mentioned before. It is available in paperback and I got my copy from Amazon.

    Simply worth every penny and worth the time to read it.

  9. be drug free 1 February 2009 at 9:31 pm #

    When will people realise that drugs are poison? the doctors prescribe DRUGS make them the biggest drug pushers in the known world but it isn’t illegal. DRUGS ARE DRUGS ARE DRUGS THEY CURE NOTHING THEY ONLY MASK SYMPTOMS AND ALL ARE DANGEROUS AND CAN INJURE YOUR BODY. SAY NO TO DRUGS IN ALL THEIR FORMS.

  10. davidf1412 18 May 2009 at 3:47 am #

    Re: “Is anyone testing for C-reactive protein in order to prescribe sensible dosage of statins.”

    I really don’t think there is any sensible dose of statins for anybody ever – even those with congenital very high cholesterol.

  11. Anthony Kesteven 26 November 2009 at 2:20 pm #

    I cannot understand why anyone would want to lower their cholesterol, particularly as there is so much information now on the internet about how low blood cholesterol is so much more dangerous than “high” cholesterol. http://www.cholesterol-and-health.org.uk lists a wide range of examples of why low cholesterol is to be avoided – all fully referenced.

    And “low cholesterol”, it seems, is not what you might think – it’s what the drug companies would class as “high”! Looking at this, I really wouldn’t want my cholesterol below about 7.

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