Cholesterol Part 8: The Latest Research


The conventional wisdom is largely based on research done decades ago, and I’ll discuss some of that in the final post. In this section I will briefly summarise more recent developments.

Atherosclerosis begins with LDL particles becoming embedded in arterial walls. It is not caused by cholesterol itself. We should therefor measure the number of particles in our bloodstream rather than estimating the amount of cholesterol contained therein. Estimating the amount of cholesterol in the bloodstream is like determining the amount of traffic based on the number of people in each vehicle. The number of vehicles is what really causes traffic.

There are different types of LDL particles, and some of them are more likely to contribute to heart disease than others. LDL particles range from large and fluffy to small and dense, and it is smaller, denser particles that cause problems. The large fluffy LDL particles seem to play little role in developing heart disease.

The research also suggests that LDL is far more problematic once it has been oxidised. This is because oxidised LDL is more likely to slip through the inner lining of the arterial wall and become stuck. SDLDL particles are also more likely to become oxidised that the larger LDL particles.

Statins frequently lead to muscle weakness, lethargy, liver dysfunction, diabetes, and cognitive disturbances. Statins are effective at reducing the risk of heart attacks in those with a pre-existing condition, but not so effective at reducing overall risk of death. For example, statins reduce the risk of heart disease in women, but they do not reduce the risk of death from all causes. In other words, they make women more likely to die from other causes, such that their total risk of death is unchanged. This TED talk has some interesting facts on statins, and pharmaceuticals in general. Most notably that the number needed to treat is 300. (Skip to the 6th minute.)

Finally, according to the INTERHEART study, which examined cardiovascular risk factors in 51 countries, 9 out of the 10 strongest risk factors for heart disease are modifiable by changes in diet and lifestyle. They include not smoking, more exercise, reducing carbohydrate intake etc. i.e. not pharmaceuticals.