The Case Against Lowering Cholesterol For Decreased Risk of Heart Disease

Heart Disease Check UpOn October 6, 2010, on the Dr Oz show, Dr Oz recommended a class of drugs for lowering cholesterol called statins, as an effective and viable option for lowering cholesterol.  I appreciate that he mentioned that this should be an option only secondary to using lifestyle and dietary factors as the primary means for maintaining cardiovascular health.  However, I would like to present a different scientifically-supported perspective for decreasing heart disease risk.

A Different Perspective on Cholesterol

Heart disease is still the number one fatal disease in the United States, accounting for 616,067  deaths per year according to the latest available statistics by the Centers for Disease Control (2007).  There are many research studies that appear to show that lowering cholesterol levels using statins is the one of the most effective means to decrease the risk of heart disease. 1 2 3

However, lowering cholesterol through using statins is not the best target for combating heart disease.  Why?  Statins increase the risk of diabetes4, and because low cholesterol under 189 is associated with increased risk of death in those over 65.5 6

Rather than lowering cholesterol, the best targets are decreasing inflammation 7 8 and reducing oxidative stress by using therapeutic lifestyle and dietary changes,9 10 and nutritional supplementation to prevent and reverse heart disease.

Some common primary markers for inflammation are blood high sensitivity C-reactive protein (HS-CRP), fibrinogen, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α).  Some markers for oxidative stress damage are urinary 8-hydroxy-2-deoxyguanosine, and blood reduced glutathione.

Dyslipidemia, a health condition characterized by elevated total cholesterol, high triglycerides, high LDL, low HDL, is a response by the body to excessive inflammation and oxidative damage. 11 12  Our body does this to use cholesterol and the other lipid components to place a cholesterol “patch” on the areas in our arteries that are damaged from inflammation13 and oxidation14 Inflammation and oxidation are the underlying processes that result in dyslipidemia.15 16  Thus, dyslipidemia is just a secondary consequence of chronic inflammation and oxidative damage to the interior lining of the blood vessels.

I know this is contrary to the message of many doctors, the mainstream media and direct-to-consumer drug TV commercials, however, the references I’ve included here are not from fringe groups, but rather from professional peer-reviewed journals.  Some written by world-renowned scientists and cardiologists.

I want to share some other perspectives on cholesterol, inflammation and oxidative stress.

Dr. Steven Sinatra, a cardiologist who writes in his book “The Sinatra Solution” about his previous conventional approach with his patients :

“At that time I had already been practicing “revolving-door” cardiology for six years…  No matter what we did, how many drugs we prescribed, or interventions we used, patients just kept coming back with more health problems…  But seeing the success my friend had with antioxidants turned a light on in my head about oxidative stress.”

He now promotes a different approach, one that use a potent anti-inflammatory diet and exercise intergrated with the use of the following nutritional supplements: high doses of coenzyme Q10, L-Carnitine, D-Ribose, and magnesium.  He calls this the metabolic cardiology approach. Dr. Sinatra agrees that high cholesterol is only a small part of the factors involved in heart disease. He writes:

“Life can’t go on without cholesterol, a basic raw material made by your liver, brain, and almost every cell in your body. Enzymes convert it into vitamin D, steroid hormones (such as our sex hormones estrogen, progesterone, and testosterone, and stress hormones), and bile salts for digesting and absorbing fats. It makes up a major part of the membranes surrounding cells and the structures within them.  The brain is particularly rich in cholesterol and accounts for about a quarter of all the cholesterol we have. The fatty myelin sheath that coats every nerve cell and fiber is about one-fifth cholesterol. Neuronal communication depends on cholesterol. It is not surprising that a connection has been found between naturally occurring cholesterol and mental function. Lower levels are linked to poorer cognitive performance.”

Dr. Mark Hyman, a well-known functional medicine practitioner, has reviewed the mechanisms of how statins could actually contribute to the causing diabetes and heart disease.

I am convinced without a doubt that combating heart disease must target decreasing inflammation and reducing oxidative stress, not primarily lowering cholesterol.  Not only are the scientific data available, I see it in the patients I have worked with using the Functional Medicine approach.

For example, recently I saw a patient who had high cholesterol and was on statins when he first came to see me.  This patient is a smoker, and in the past, has made many efforts to stop smoking.  Early this year, his cholesterol while on statins was dangerously low at 116. The levels of his inflammatory indicators and oxidative stress markers were unfortunately not measured by his previous doctor.  Besides the statin drug, he was on another drug that blocks cholesterol absorption, and another drug for erectile dysfunction.  He stopped taking the drugs and began following my program which is summarized as follows:

  • Diet: Significantly increased amounts of dark green leafy and brightly colored vegetables, high omega-3 fatty acid fish, poultry and beef, other “good fat” sources such as avocados and coconut milk, significantly decreased grains, increased intake of beans, lentils, legumes and nuts.  Continue drinking 1 glass red wine per day.
  • Lifestyle Modifications: Exercise of walking and calisthenics 4 days per week.  Relaxation exercises of deep breathing for 5 minutes each day.  He stopped use of a computer or any other bright light source after 10 PM at night (this suppresses melatonin production).  He tried to stop smoking but only reduced the use of cigarettes.
  • Supplements:  A medical food powder containing the anti-inflammatory herbs curcumin and reduced iso-alpha acids from hops.  A high dose multivitamin and multimineral with the active, absorbable forms of vitamins.  Extra pantethine, niacin, active forms of vitamin E, and R-lipoic acid.  Moderate doses of fish oil.   High doses of CoQ10, 17 18 L-carnitine, and D-ribose.

As of last month, his total cholesterol is now a healthy 174, even though he is still smoking.  His most recent inflammatory and oxidative stress markers are now all within normal ranges. Seeing the results, he is finally motivated to completely stop smoking and incorporate this functional medicine approach to truly reduce the risk of a heart attack and combat heart disease.  By targeting inflammation and oxidative stress, rather than lowering cholesterol, he has greatly decreased the risk of progressive heart disease.

If you are skeptical about the information I presented above, I encourage you to review the references I have provided.  Let me know whether you think the various scientific data support the approach that using therapeutic lifestyle changes, nutrition and nutritional derivatives in targeting inflammation and oxidative stress are more effective for heart disease than primarily lowering cholesterol levels. Post a comment.

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References:

  1. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).  Lancet. 1994;344:1383-1389
  2.  Hamilton C, Miller W, Al-Benna S, et.al. Strategies to reduce oxidative stress in cardiovascular disease. Clinical Science. 2004;106:219-234.
  3. Nissen S,  Tuzcu E, Schoenhagen P,  et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis. JAMA 2004;291:1071–1080.
  4.  Sattar N, Preiss D, Murray H, et. al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet. 2010;375:735-742.
  5.  Brescianini S, Maggi S, Farchi G, et. al. Low total cholesterol and increased risk of dying: are low levels clinical warning signs in the elderly? Results from the Italian Longitudinal Study on Aging. J Am Geriatr Soc. 2003;51:991-6.
  6.  Schupf N, Costa R, Luchsinger J, et.al. Relationship between plasma lipids and all-cause mortality in nondemented elderly.  J Am Geriatr Soc. 2005;53:219-26.
  7.  Ross R. N Engl J Med. 1999;340:115-126.
  8.  Hansson GK. N Engl J Med. 2005;352:1685-1695.
  9.  Ornish D, Scherwitz L, Billings J, et. al.  Intensive lifestyle changes for reversal of coronary heart disease. JAMA.1998;280:2001-2007.
  10.  de Lorgeril M., Renaud S., Mamelle N., et. al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet.1994;343:1454-1459.
  11.  Witztum J, Berliner J. Oxidized phospholipids and isoprostanes in atherosclerosis. Curr Opin Lipidol. 1998;9:441-448
  12. Schmidt A, Yan S, Wautier J, Stern D. Activation of receptor for advanced glycation end products: A mechanism for chronic vascular dysfunction in diabetic vasculopathy and atherosclerosis. Circulation Research. 1999;84:489-497
  13.  Libby P. Inflammation: a common pathway in cardiovascular diseases. Dialogues in Cardiovasc Med. 2003;8:59-73.
  14.  Smith C,Mitchenson M, Aruoma O, et. al. Stimulation of lipid peroxidation and hydroxyl-radical generation by the contents of human atherosclerotic lesions. Biochem. J. 1992; 286:901-905.
  15. Malaguarnera M, Vacante M, Avitabile T, et. al.  L-Carnitine supplementation reduces oxidized LDL cholesterol in patients with diabetes. Am J Clin Nutr 2009;89:71-76
  16. Libby P, Geng Y, Aikawa M, et. al.  Macrophages and atherosclerotic plaque stability. Curr Opin Lipidol. 1996;7:330-335
  17.  Khatta M, Alexander B, Kritchten C, et al.  The effect of coenzyme Q10 in patients with congestive heart failure. Ann Intern Med 2000;132:636-40.
  18.  Keogh A, Fenton S,Vetsc L, et al. Randomised double-blind, placebo-controlled trial of coenzyme Q10 therapy in class II and III systolic heart failure. Heart, Lung and Circulation 2003;12:135-141

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