Why lowering cholesterol isn’t nearly as important as you think
Last year, cardiologist Stephen Sinatra and I wrote a book—The Great Cholesterol Myth—which will be out later this year. We believe that a weird combination of misinformation, questionable studies, corporate greed, and deceptive marketing has conspired to create one of the most damaging myths in medical history: that cholesterol causes heart disease.
The tragedy is that by putting all our attention on cholesterol, we’ve ignored the real causes of heart disease: inflammation, oxidation, stress, and sugar. Things we can actually control with foods, supplements, and lifestyle changes—none of which have the costs or side effects of pharmaceutical drugs.
What evidence do we have that the cholesterol hypothesis is flawed? Let’s start with some surprising facts.
- Cholesterol levels are a poor predictor of heart attacks
- Half of heart attacks happen to people with normal cholesterol
- Half the people with elevated cholesterol have healthy hearts
- Lowering cholesterol has an extremely limited benefit
I haven’t come to these conclusions lightly, and I wouldn’t expect you to take them at face value. The case against cholesterol as a cause of heart disease has been crumbling for decades, but getting the information out there hasn’t been easy. After all, the top cholesterol-lowering medications, Lipitor and Zocor, bring in roughly $34 billion a year for their makers, who have a strong interest in keeping the cholesterol theory alive.
To really see the case against conventional wisdom, you need to consider the following three studies:
The Lyon Heart Study: In the 1990s, French researchers decided to run an experiment—known as the Lyon Diet-Heart Study—to test the effect of different diets on heart disease. They took two groups of men who had every risk factor imaginable. All of them had survived a heart attack. They all had high cholesterol. They all smoked. None of them exercised. And they all had high levels of stress.
Half of the men were advised to eat the American Heart Association’s “prudent diet” (low in saturated fat and cholesterol), while the other half were advised to eat a Mediterranean diet high in fish, omega-3s, vegetables, and monounsaturated fats such as olive oil.
The study was halted early because the reduction in fatal heart attacks in the Mediterranean group was so great—70 percent—that researchers decided it was unethical to continue.
Guess what happened to the cholesterol levels in the subjects on the Mediterranean diet. They didn’t budge. Their cholesterol levels were just as high when the study was stopped as they were when it began. They just stopped dying. Cholesterol had nothing to do with it.
The ENHANCE trial: This 2008 study tested a combination cholesterol-lowering medication called Vytorin. The new wonder drug lowered cholesterol just fine. In fact, it lowered it better than standard statin medications. The problem was that the people taking Vytorin had almost twice the arterial plaque growth as the people taking the standard medication.
To put it simply, the study participants who took the cholesterol-lowering wonder drug saw their cholesterol levels go down significantly while their risk for heart disease went up.
The Nurses Health Study: The Nurses Health Study is one of the longest-running studies of diet and disease ever undertaken. In an analysis of 84,129 of the participants, published in the New England Journal of Medicine, five factors were identified that significantly lowered the risk for heart disease. In fact, wrote the authors, “Eighty-two percent of coronary events in the study. . . could be attributed to lack of adherence to (these five factors).”
- Don’t smoke.
- Drink alcohol in moderation.
- Engage in moderate-to-vigorous exercise for at least half an hour every day.
- Maintain a healthy weight (BMI under 25).
- Eat a wholesome, low-glycemic (low sugar) diet with plenty of omega-3 fats and fiber.
But not a word about cholesterol.
These studies are just a sample of the evidence against the cholesterol theory. The Framingham Heart Study, which began in 1948 and is still going on, actually shows clearly that high cholesterol is protective in older adults—those in the study who lived the longest tended to be those in the “highest cholesterol” category. And let’s not forget that cholesterol is also the parent molecule for the sex hormones and vitamin D. Plus, it’s vitally important in the brain where it helps make communication between cells easier.