Chicago Life

Does cholesterol really cause heart disease?

By MARILYN SOLTIS

Every year over 2 million people in the U.S. have heart attacks or strokes. Doctors regularly prescribe statin drugs to lower cholesterol and prevent coronary disease. Subsequently, the market for these cholesterol-lowering drugs is a staggering $30 billion a year..But, what if the premise that cholesterol is the major player in causing heart disease, is false? In a new book, The Great Cholesterol Myth by Jonny Bowden, Ph.D., C.N.S. and Stephen Sinatra, M.D., F.A.C.C., the case for cholesterol and heart disease is highly disputed, with the authors citing many peer-reviewed studies and their own experience treating patients.

The authors talk about a number of famous studies including one most referenced by defenders of the cholesterol as bad theory—The Framingham Heart Study, a long-running research study that began in 1948 and monitored heart disease in over 5,000 residents of Framingham, Massachusetts.

After 16 years, it was pronounced that there was a direct correlation between cholesterol levels and heart disease. But it turned out that some people who had low cholesterol levels developed heart disease. Thirty years later, it was discovered that once men passed the age of 47 it didn’t matter if cholesterol levels were low or high. Men with high cholesterol lived just as long as men with low cholesterol.

The book notes that forty-four years after the Framington study began, the director William Castelli, M.D., wrote in the Archives of Internal Medicine:

“In Framingham, Mass., the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person’s serum cholesterol…we found that people who ate the most cholesterol, ate the most saturated fat and ate the most calories, weighed the least and were the most physically active.”

Another study is the $415 million National Institutes of Health study, the Women’s Health Initiative, famous for answering the question about hormone therapy after menopause being more risky than beneficial. For eight years, 49,000 people from the age of 50 to 79 were followed to see if a low fat diet reduced the risk of getting heart disease or cancer. In 2006 the New York Times reported that a low fat diet had no effect.

In fact, many studies now show that cholesterol levels are a poor predictor of heart attack. Half the people with heart disease have normal cholesterol and half the people with elevated cholesterol have healthy hearts.

If it isn’t cholesterol, what does cause heart disease? There is increasing evidence that the primary cause of heart disease is chronic inflammation, which has no obvious symptoms. Yet, chronic inflammation, according to the authors, “is a significant component of virtually every single degenerative condition, including Alzheimer’s, diabetes, obesity, arthritis, cancer, neurodegenerative diseases, chronic lower respiratory disease, influenza and pneumonia, chronic liver and kidney diseases, and, most especially, heart disease.”

There are dietary causes of heart disease but it turns out fat isn’t the problem.

According to the book’s authors, “the number one dietary contributor to heart disease is sugar, which is a far greater danger to your heart than fat. Sugar contributes to inflammation in the artery walls and drives up the hormone insulin which raises blood pressure and increases cholesterol. Triglycerides are raised by sugar and processed carbs and when sugar is in the bloodstream it creates damaging and toxic molecules, called advanced glycation end products. It also damages LDL, leading to inflammation.

The controversy over high-fructose corn syrup regularly found in processed foods and “natural” sugar has been raging for a while. The Corn Refiners Association maintains that corn syrup is no worse than regular sugar. Bowden and Sinatra say, “Sadly, the association is technically right. Fructose is the damaging part of sugar and whether you get that fructose from regular sugar or from HFCS doesn’t make a whit of difference. It’s the fructose in each of them that’s causing the damage.”

High-glycemic carbohydrates were also found to increase the risk for heart disease in some studies. “Bad” carbs include cereals, white rice, pasta, breads, cookies, pastries, snack foods, sodas, juice drinks, and crackers. “Good” carbs are simply fruits, vegetables and beans and legumes.

Stress is a major factor in creating inflammation. Too many of the stress hormones, cortisol and adrenaline, can contribute to heart disease. The book reports that when stress persists, the abundance of cortisol begins to promote hardening of the arteries. Stress can cause an overproduction of platelets in the blood which can clump together and create a clot, or thrombus. When it blocks an artery, that’s what causes a heart attack.

If you have a lot of stress in your life and a horrific diet, there is an antidote that has been found to work—community and connection. Medical researchers began to look at Roseto, Pennsylvania in the 1960’s where heart disease was almost zero for men aged 55 to 64. Men over 65 had heart attacks at less than half the national average. They labored in underground slate mines, their food was fried in lard, and almost all of them smoked.

What researchers found was a community where three generations of family lived in most houses, dinners fried in lard nourished the spirit and everyone worked to create a better life for their children. Stress was shared by everyone, thus no one felt overwhelmed by the problems of life. Later labeled The Roseto Effect, researchers found that community and connection were far better predictors of heart health than cholesterol levels or smoking.

National Institutes of Health
The National Heart, Lung and Blood Institute, part of the National Institutes of Health, announced the launch of an international multi-site trial last August to determine whether a common anti-inflammatory drug can reduce heart attacks, strokes, and deaths due to cardiovascular disease in people at high risk for them.

The Cardiovascular Inflammation Reduction Trial will randomly assign participants who have had a heart attack within the past five years and who also have type 2 diabetes or metabolic syndrome, an inexpensive generic drug called methotrexate, or a placebo for three to four years. The drug is now used at low doses to treat rheumatoid arthritis and at higher doses to treat some forms of cancer such as leukemias and lymphomas.

According to the NIH: “Adults who have type 2 diabetes are much more likely to die of heart disease or stroke than people without type 2 diabetes. Metabolic syndrome—a cluster of traits that include a large waistline, high blood pressure, high levels of blood triglyceride (a type of fat) high blood sugar, and low blood HDL (the good cholesterol)—also raises the risk of heart attack and stroke. Many people with type 2 diabetes and obesity also have metabolic syndrome. People with diabetes or metabolic syndrome typically have elevated blood levels of various markers of inflammation.”

The study will also determine if low doses of the drug reduces death from all causes and certain heart and blood vessel-related conditions and events including incident deep vein thrombosis, pulmonary embolism, atrial fibrillation, hospitalizion for chest pain or congestive heart failure, non-surgical procedures or coronary artery bypass surgery, and newly diagnosed type 2 diabetes. A blood and DNA bank will be established to study the drug’s effect on a number of inflammatory biomarkers.

Seven thousand patients will be enrolled at 350 to 400 sites across the U.S. and Canada. Patient recruitment starts in March 2013.

What you can do to prevent heart disease
The authors of The Great Cholesterol Myth believe that the following can lead to healthier outcomes:

Ask your doctor for these tests, which are more important than the standard test for cholesterol: