Cholesterol Myth / Heart Disease Myth - I've become suspicious of the current model that high blood cholesterol (LDL) is directly related to coronary heart disease risk (CHD). Operating from this belief, doctors prescribe drugs which reduce blood LDL levels thinking this effect also reduces the heart disease risk (CHD). Specifically, I'm referring to the widespread acceptance of statin drugs (Crestor, Zocor, Lipitor, etc.).

Statins clearly reduce LDL, but they carry with them other effects that may be more relevant to reducing CHD risk than their impact on LDL levels. It's like thinking that if we can stop gray hair, we can stop aging. Gray hair is a symptom of aging, but not likely a cause. Similarly, LDL may be a symptom of CHD risk, but NOT likely a cause.

However, as I make clear below, I don't think high LDL is necessarily a symptom of high CHD risk.

Work in progress. I hope to have study citations to support each assertion listed below in what I hope will be a more comprehensive model of coronary heart disease (CHD).

All LDL molecules are not alike

High LDL alone does not imply higher heart disease risk - It appears that the size of the LDL molecules matters. Small LDL molecules appear to increase risk of CHD. Large LDL molecules seem to reduce CHD risk.

Saturated fats increase levels of large LDL molecules - and large LDL molecules do not increase CHD risk. Saturated fats increasing LDL makes sense since the body needs to take the triglicerides from the staturated fat and get them to the cells--that's LDL's job...or is it a by product? The liver produces VLDL. LDL is the the resulting molecule when VLDL delivers triglicerides to the body's cells, right?

Oxidized LDL increases heart disease risk - so high levels of oxidized LDL does increase CHD risk.

Even lower LDL does not mean even lower CHD risk - Doctors believe that by controlling cholesterol with statins can control heart disease risk. And they belief that lower is better. Evidence does not support the lower is better assertion, which suggest the beneficial role of statins does NOT lie it's ability to reduce cholesterol levels, but in some of it's other effects, such as inflamation reduction and anticoagulant properties.

Role of glucose and fructose on vessel wall damage

Blood glucose

Role of Lp(a) in clot formation and atherosclerosis

When the endothelium of a coronary artery suffers an injury (from inflammation or some other factor), Lp(a) and plasminogen compete to attach to the injured endothelium. If plasminogen wins, it creates a clot but that clot will break apart when "activated" by plasminogen activator (tPA) molecule. However, if Lp(a) wins, it creates a stubborn clot that won't break up. Instead, the Lp(a) clot eventually becomes incorporated into the inner cell wall. Usually, it will be cleaned out by the body's normal immune response (macrophases mostly). However, if this Lp(a) injury and repair process is repeated at the same injury site over and over again, the immune cleanup response can't keep up and a atherosclerotic lesion develops.

References on Cholesterol Myth

What's Cholesterol Got to Do With It? - New York Times
"Vytorin is a combination of cholesterol-lowering drugs, one called Zetia and the other a statin called Zocor. Because the two drugs lower LDL cholesterol by different mechanisms, the makers of Vytorin (Merck and Schering-Plough) assumed that their double-barreled therapy would lower it more than either drug alone, which it did, and so do a better job of slowing the accumulation of fatty plaques in the arteries -- which it did not."
LDL Cholesterol: 'Bad' Cholesterol or Bad Science? (PDF)
Journal of American Physicians and Surgeons, 10 (3), Fall 2005. Compelling article by Anthony Colpo. However, I think his conclusion could have been more powerful given the evidence he lays out--and the evidence is superbly presented.
A Reply to Wu and Schauss Criticism of Colpo's 2005 Journal of American Physicians and Surgeons article (beginning on page 2), along with Anthony's reply (page 3) (PDF)
Wu and Schauss offer a condescending rebuttal to Colpo's sometimes condescending article, but I didn't think they refuted Colpo's main points, which Colpo points out in his response.
The Cholesterol Myths: Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease
by Uffe Ravnskov
The Great Cholesterol Con
by Anthony Colpo
The Great Cholesterol Con: The Truth About What Really Causes Heart Disease and How to Avoid It
by Dr. Malcolm Kendrick

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