*The information presented in this blog is solely for educational purposes and is not intended as medical advice. If you have specific medical concerns, consult with your primary healthcare provider before making any changes to your medication intake*

For many years, dietary guidelines have cautioned against consuming foods high in cholesterol based on the belief that dietary cholesterol contributes to the buildup of plaque in arteries, leading to heart disease. However, a growing body of evidence challenges this long-held view, suggesting that the relationship between dietary cholesterol and heart disease is not as straightforward as once thought.

Recent analyses have brought to light significant findings that question the traditional stance on cholesterol and heart disease. A 2018 review highlighted that high levels of LDL (often referred to as “bad cholesterol”) and total cholesterol are not reliable indicators of heart disease risk, casting doubt on the effectiveness of statins as a preventative measure.(1)

Further scrutiny has revealed that some studies supporting the cholesterol-heart disease link may have skewed data and interpretations to align with their hypotheses. Moreover, the link between cholesterol levels and cardiovascular disease (CVD) appears to be weak or non-existent in numerous studies.(2) Contrary to the belief that high LDL levels are harmful, evidence shows that older adults with elevated LDL cholesterol often live longer than those with lower levels or those taking statin medications.(3) 

Considering that one out of every four Americans aged 45 and above is prescribed statin medication to manage cholesterol levels, it’s critical to thoroughly examine the potential overprescription of these drugs, along with their associated risks and side effects.(4)

Before we go any further, let’s go over the different types of cholesterol in the body:

1. Total Cholesterol—This is a measure of all the cholesterol in your blood. It includes low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and very low-density lipoprotein (VLDL) cholesterol. Total cholesterol is used as a general indicator of your risk for heart disease, but it’s the individual components of your cholesterol profile that provide a more accurate picture.

2. Low-Density Lipoprotein (LDL) Cholesterol—Traditionally labelled as “bad” cholesterol, LDL is responsible for delivering cholesterol to cells, where it’s used in membranes or for making hormones. Emerging research suggests that while LDL is involved in the process of atherogenesis (the formation of fatty plaques in the arteries), its role is more complex than previously understood. Factors such as particle size, density, and the body’s inflammatory response play significant roles in cardiovascular disease risk rather than LDL levels alone.(5)

3. High-Density Lipoprotein (HDL) Cholesterol—HDL is known for its higher density due to a greater proportion of protein. HDL scavenges cholesterol from the bloodstream, as well as from plaques in the arteries, and transports it back to the liver for excretion or reuse. This process is protective against atherosclerosis, earning HDL its reputation as “good” cholesterol.

4. Very-Low-Density Lipoprotein (VLDL) Cholesterol—VLDL is similar to LDL but contains mostly triglycerides, with less protein and cholesterol. VLDL transports triglycerides to tissues in the body. After delivering triglycerides, VLDL becomes LDL. Like LDL, it can contribute to the development of plaque deposits, but its primary concern is its triglyceride content rather than cholesterol.

5. Triglycerides—While not a type of cholesterol, triglycerides are often measured alongside cholesterol levels in a lipid panel. Triglycerides are the most common type of fat in your body. High levels can contribute to atherosclerosis, especially when associated with low HDL or high LDL levels, although the relationship is influenced by factors such as genetic predisposition and lifestyle.

Why Our Bodies NEED Cholesterol

Brain Health

While often vilified, cholesterol is actually a fundamental component of our well-being. 

Constituting up to 30% of the brain’s mass, cholesterol is indispensable for the development and maintenance of neuronal plasticity and synapse formation.(6) These processes are vital for thought, learning, memory formation, and overall cognitive function. Maintaining adequate cholesterol levels is a necessity for brain health. One notable study involving nearly 4,000 participants over the age of 50 found a significant inverse association between levels of LDL cholesterol and the risk of dementia.(7) This research suggests that higher levels of LDL cholesterol could be considered a protective factor against cognitive decline. Such findings challenge the prevailing narrative that cholesterol reduction, often achieved through statin therapy, is universally beneficial.

Beyond brain health, cholesterol serves as a building block for cell membranes, providing the structural integrity cells need to maintain their shape, fluidity, and function. This structural role is crucial for the proper functioning of every cell in the body, enabling cells to communicate with one another and perform their specialized functions effectively.

Cholesterol is also the precursor for the synthesis of all steroid hormones, including sex hormones like testosterone and estrogen, as well as hormones produced by the adrenal glands, such as cortisol, which regulates metabolism and stress response. These hormones are vital for the regulation of a wide array of physiological processes, from reproductive function and body composition to immune response and mood regulation.

Furthermore, cholesterol is involved in the production of bile acids, which are essential for the digestion and absorption of dietary fats and fat-soluble vitamins (A, D, E, and K). Without adequate cholesterol, our bodies would struggle to utilize the fats and vitamins that are crucial for energy production, cellular repair, and overall health. We also need cholesterol to synthesize vitamin D. When skin is exposed to sunlight, cholesterol in the skin is converted into vitamin D, a nutrient essential for bone health, immune function, and inflammation regulation.

The narrative surrounding cholesterol, particularly LDL cholesterol, is shifting from a focus on its risks to a more balanced understanding of its essential contributions to human health. This nuanced perspective encourages a more individualized approach to managing cholesterol levels, considering the diverse and vital roles cholesterol plays in the body and brain.

Statins: Cholesterol Panacea or Problematic Prescription?

While statins are widely prescribed to lower cholesterol levels and reduce the risk of heart disease, the relationship between cholesterol and heart health is more complex and nuanced than previously thought. The reduction of cholesterol alone does not necessarily correlate with a proportional decrease in the risk of heart disease or heart-related deaths.(8) In fact, the absolute benefit of statins is surprisingly minimal: for every 100 individuals treated, only about one person is spared a heart attack.(9) This statistic starkly illuminates the limited impact of statins on overall cardiovascular disease prevention and underscores the need for a broader perspective on heart health that goes beyond cholesterol levels.

This ongoing debate around statin therapy points to the need for a reevaluation of their role in cardiovascular disease prevention. The broad prescription of these drugs, based on an oversimplified model of cholesterol’s role in heart disease, ignores the individual complexities of cardiovascular risk and the multifactorial nature of heart health.

A meta-analysis from 2015 examining statin trials found that these drugs extend life by only a few days in both primary and secondary prevention scenarios.(10)This revelation came after years of research failed to conclusively connect dietary cholesterol intake with heart disease, leading to a brief moment back in 2015 when dietary guidelines no longer deemed cholesterol a concern. Yet, recent guidelines have reverted to cautioning against cholesterol, a move criticized by many as ignoring the latest evidence and possibly influenced by the interests of statin manufacturers.

Risks and Side Effects of Statin Drugs

The ongoing debate surrounding the use and efficacy of statin drugs in the prevention of heart disease is underpinned by growing concerns regarding their associated risks and the overestimation of their benefits. While statins are commonly prescribed to lower cholesterol levels in the hope of reducing the risk of heart disease, emerging evidence suggests that their potential harm may outweigh the supposed benefits. 

Among the most concerning issues: 

Neuromuscular Diseases

The link between statin use and the development of neuromuscular diseases, such as amyotrophic lateral sclerosis (ALS) is quite concerning.(11) This association raises serious questions about the long-term implications of statin therapy on neurological health, suggesting that the drive to lower cholesterol could inadvertently harm the brain and nervous system.

Increased Diabetes Risk

Statins have been shown to significantly increase the risk of developing type 2 diabetes, a condition that elevates the risk of cardiovascular disease.(12) Research indicates a 38% increased risk among statin users, presenting a paradox where a medication prescribed to prevent heart disease could lead to another serious health condition that contributes to cardiovascular risk.

Depletion of Essential Nutrients

Statins interfere with the body’s synthesis of critical nutrients, including Coenzyme Q10 (CoQ10) and Vitamin K2, essential for energy production and heart health. The depletion of CoQ10 can lead to muscle weakness and increased risk of acute heart failure, while the reduction in Vitamin K2 can worsen cardiovascular health—outcomes that are diametrically opposed to the intended benefits of statin therapy.(13)

Muscle Health and Heart Failure

Statins have been associated with a range of musculoskeletal disorders, from mild myalgia to severe autoimmune muscle diseases.(14) This impact on muscle cells, including those in the heart, can compromise heart function and contribute to heart failure, a concerning outcome for drugs intended to protect heart health.

This critique of statin therapy is not a denial of their potential benefits for certain individuals but a call for a more nuanced and personalized approach to cardiovascular disease prevention. Factors such as lifestyle, diet, and the specific risk profile of the individual should play a central role in determining the best course of action. For some, the risks of statin therapy may outweigh the benefits, highlighting the importance of informed decision-making and the consideration of alternative strategies for heart disease prevention.

Alternative Biomarkers For Assessing Cardiovascular Disease Risk 

Understanding and managing your risk factors for heart disease is crucial for prevention. While a total cholesterol reading might seem important, its ability to predict heart disease risk is limited, especially if the number is under 300. More telling indicators include the levels of low-density lipoprotein (LDL) and triglycerides, particularly if they’re high, and high-density lipoproteins (HDL), especially if they’re low. To get a clearer picture of your heart disease risk, consider the following:

  • HDL/Total Cholesterol Ratio: The percentage of HDL in your total cholesterol is a significant indicator of heart disease risk. Ideally, this percentage should be above 24%.
  • Triglyceride/HDL Ratio: Similar to the above, this ratio should ideally be below 2%.
For a more precise evaluation of heart disease risk, the following tests can be helpful:
  • NMR LipoProfile: This test distinguishes between large, benign LDL particles and small, dense, potentially harmful LDL particles. Understanding the particle size can help tailor heart disease prevention strategies more effectively, focusing on the particles that pose a real risk to cardiovascular health.
  • Gamma-Glutamyl Transpeptidase (GGT): GGT is an enzyme involved in the metabolism of glutathione and plays a role in the body’s detoxification process. Elevated levels of GGT are associated with increased oxidative stress and inflammation, which can damage cardiovascular health.(15) Monitoring GGT levels can serve as an early marker for potential heart disease risk and can indicate the need for dietary and lifestyle changes to reduce inflammation and oxidative stress.
  • Apolipoprotein B (apoB): This test measures the level of apoB in the blood, a protein that is a principal component of low-density lipoprotein (LDL) particles and very low-density lipoprotein (VLDL) particles. Because each LDL and VLDL particle contains one apoB molecule, the apoB level is a direct indicator of the number of potentially atherogenic particles in the bloodstream. High levels of apoB are strongly associated with an increased risk of cardiovascular disease.(16) The apoB test provides a more accurate reflection of heart disease risk than traditional cholesterol tests alone, as it directly measures the particles responsible for depositing cholesterol in the arterial walls, leading to plaque formation and cardiovascular disease. Monitoring and managing apoB levels can be a key component in preventing heart disease and improving cardiovascular health.
Additional metrics that can help to predict risk factors for cardiovascular disease:

Fasting Insulin Level: Elevated fasting insulin levels are a clear marker of insulin resistance, a condition where the body’s cells become less responsive to insulin’s action of moving glucose from the bloodstream into cells. This condition is not only a precursor to diabetes but also to heart disease, as it is closely linked with other risk factors such as high blood pressure, obesity, and abnormal cholesterol levels.(17) 

Fasting Blood Sugar Level: Blood sugar levels in the fasting state offer a snapshot of how well the body manages glucose. Levels ranging from 100 to 125 mg/dl are categorized as prediabetes, significantly increasing the risk of developing coronary heart disease compared to levels below 79 mg/dl.(18) These elevated levels indicate that glucose is not being efficiently utilized by the body. Click HERE to read a previous blog I wrote all about blood glucose monitoring and strategies to help regulate blood sugar.

Iron Level: While iron is essential for numerous bodily functions, including oxygen transport and cellular energy production, excessive iron can be harmful. High iron levels can catalyze the production of free radicals, leading to oxidative stress and endothelial damage, which can increase the risk of heart disease.(19) Monitoring serum ferritin, a blood cell protein that contains iron, gives an indication of the body’s iron stores. Keeping ferritin levels below 80 ng/ml is generally recommended to prevent the potential oxidative damage associated with excess iron. A simple and effective way to manage high iron levels is through blood donation, which can help decrease ferritin levels and reduce the risk of heart disease.(20)

By keeping these metrics in check, incorporating a balanced diet, consistent exercise, and positive lifestyle adjustments, you can take proactive steps toward managing your risk factors for heart disease. If you’re interested in exploring your health and personal biomarkers independently of the traditional healthcare system, InsideTracker offers an online platform that conducts a range of tests. Analyzing your blood, DNA, and lifestyle habits, aids in assessing your health risks and devising a tailored action plan for future wellness.

In the pursuit of health, knowledge is power, and action is transformative; the heart of the matter truly lies in our daily choices.

In-Text References

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General HealthThe Stats on Cholesterol Medication—A Closer Look at the Evidence