Cholesterol Facts vs. Myths

Belief in the "Great Cholesterol Myth" has caused us to neglect the real causes of heart disease while obsessively focusing on an innocuous molecule that's essential for life and that we believe has only a minor role in heart disease.

The Great Cholesterol Myth is really a series of related myths that impact everything from our diet to the way we treat heart disease. Here are several of what we believe to be the biggest ones:

Myth: High cholesterol is a good predictor of heart attacks.

Fact: High cholesterol is a terrible predictor of heart attacks.

More than half the people admitted to hospitals with cardiovascular disease have normal cholesterol, and plenty of people with elevated cholesterol have perfectly healthy hearts.

A much better indicator of your overall risk for heart disease is the triglycerides to HDL ratio. If, for example, your triglycerides are 100 and your HDL is 50 your ratio is 2. If, however, your triglycerides are 150 and your HDL is 30, your ratio is 5. A ratio of 2 or under is excellent. A ratio of 4 is considered high, with increased risk.

One Harvard study, published in the journal Circulation, showed that the people with the highest ratio of triglycerides to HDL had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL. In fact, the ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio.

Myth: High cholesterol is the cause of heart disease.

Fact: Cholesterol is a fairly insignificant player in heart disease.

Inflammation is the primary cause of heart disease. Here's what happens: Small injuries in the lining of the arteries become inflamed. Small, dense, oxidized (damaged) LDL-B cholesterol particles (among other things) get trapped at the site of the injury; oxidative damage and inflammation increases, ultimately creating a kind of toxic brew that can turn into plaque. Only oxidized, small-particle LDL cholesterol is a problem, and it's only a problem when there's inflammation.

Myth: Lowering cholesterol with statin drugs will prolong your life.

Fact: There is conflicting data on whether statins have any impact on longevity.

The majority of cholesterol-lowering studies don't show any difference in death rates between patients who take statins and patients who don't. In the PROSPER study, statin use in women with known heart disease resulted in a small reduction in mortality from heart disease; however, this was offset by additional deaths from cancer and other mortalities, so the overall net "gain" in terms of lives saved was a big fat zero.

Myth: Statin drugs are perfectly safe.

Fact: Statin drugs have significant side effects, including loss of memory and libido, muscle pain and fatigue.

University of California San Diego researchers found that the majority of doctors dismissed some important side effects that may have been caused by statins. Approximately 65% of doctors in their study missed some side effects or failed to connect some complaints with the medication. Meanwhile, side effects such as forgetfulness, loss of sex drive, fatigue, and muscle pain and worse continue to be reported.

Myth: Statin drugs are appropriate for men, women, children and the elderly.

Fact: The only group in which statins have been shown to have even a modest effect is in middle-aged men who've already had a heart attack.

A 2004 study in the Journal of the American Medical Association by Judith Walsh, MD (4) found that statin drug treatment to reduce cholesterol in women provided no mortality benefit. A 2007 study claims there is no evidence to show that giving statins to women keeps them free of heart disease, and statin drugs have never been tested long term on children.

Myth: Saturated fat is dangerous.

Fact: Recent peer-reviewed studies have shown no association of saturated fat with heart disease.

Two major studies in the last few years concluded that there was no association between saturated fat intake and heart disease. In one study, the researchers wrote, "Intake of saturated fat was not associated with an increased risk of coronary heart disease or stroke, nor was it associated with an increased risk of cardiovascular disease."

Myth: The higher your cholesterol, the shorter your lifespan.

Fact: In the Framingham Study, the people who actually lived the longest had the highest cholesterol.

One study published in the Journal of the American Geriatric Society found that those with cholesterol levels lower than 189 were far more likely to die than those with the highest cholesterol levels. "Subjects with low total cholesterol levels are at higher risk of dying even when many related factors have been taken into account," the researchers wrote.

Myth: A high-carbohydrate diet protects you from heart disease.

Fact: Diets that substitute carbohydrates for saturated fat may actually increase the risk for heart disease.

A study by Dariush Mozaffarian of Harvard found that in postmenopausal women, greater saturated fat intake was associated with less progression of coronary atherosclerosis, while carbohydrate intake was associated with a greater progression. This finding was so surprising that the American Journal of Clinical Nutrition published an editorial called "Saturated Fat Prevents Coronary Artery Disease? An American Paradox." The Mozaffarian study, published in the American Journal of Clinical Nutrition, found that replacing saturated fats with high-glycemic index carbs was associated with a 33% increase in heart attack risk.