Cholesterol levels have been related to the risk of heart attack and stroke for decades now, but there still seems to be a fair amount of confusion about how to approach this blood test and make sense of what it means, and what to do about the levels if they seem to be high.
The main point of this video is to emphasize one thing: Lowering your cholesterol levels does not necessarily reduce your risk of heart attack. So, while cholesterol levels are important, we should not lose sight of the primary purpose here: Reducing the risk of heart attack.
Let’s make sure we first discuss how we might figure out what someone’s risk of having a heart attack really is.
It is still controversial as to why we have an epidemic of heart disease. It’s been 40 years since a big study in Massachusetts, called the Framingham heart study, established that people were at higher risk of heart attack if they were older, male, smokers, had diabetes, a family history of heart disease, and/or were on medications for high blood pressure. And high cholesterol?
Despite all the advances in modern medicine over the last 40 years, beyond assessing the same risk factors–age, gender, smoking status, family history, diabetes, high blood pressure, and cholesterol levels–we have not found any further non-invasive tests to help us figure out somebody’s risk of having a heart attack.
Of these risk factors, you can’t change your age, your gender, or your family history, but you may be able to tackle diabetes, high blood pressure, and your cholesterol levels. However, there is no consensus on how to change your cholesterol levels.
There are 4 or 5 classes of medications that can lower your cholesterol levels, but only one of these groups of medications, those that are called statins (like atorvastatin or rosuvastatin), which have brand names Lipitor or Crestor, has been shown to reduce your risk of heart attack. So, while it is possible to make cholesterol levels look better, those non-statin drugs will not convincingly reduce your risk of a heart attack.
Statins convincingly reduce your risk of heart attack by at least 25%, so that means if you have a starting risk of 40% chance of having a heart attack over the next 10 years, and you take a statin pill every day for the rest of your life, your risk would go down to 30%. Conversely, if your starting risk of having a heart attack is only 8%, your risk of having a heart attack after taking statins would only go down to 6%, an absolute difference of 2% which many people might not see as worthwhile.
If you are at high risk, you stand to benefit more from taking a statin medication every day, and I would encourage you to consider this if your risk is above average: that is, above 20%.
You might have noticed that what people eat, or how active they are, are not even mentioned as risk factors in the traditional calculation. This would be because these factors are difficult to measure, and do not fit very easily into a calculation to measure someone’s risk.
I have also not gone into details concerning “good” cholesterol and “bad” cholesterol.
Those of us old enough to remember commercials from the 1980s and ‘90s showing clogged kitchen-sink pipes being compared to clogged coronary arteries will be more likely to believe that eating fatty foods and foods high in cholesterol will clog our arteries, too. This has come to be seen as common sense and “conventional wisdom”, but it turns out not to be as straightforward as that. In fact, it is my conclusion that there is no proof that eating saturated fat and cholesterol causes fat or cholesterol to accumulate in our blood.
Does all this mean that diet doesn’t make a difference? Not at all.
I’ve taken a particular interest in this topic as I have a strong family history of heart disease. Close family members have had heart attacks in their 40s and 50s, and one member of my family even had a heart attack at the age of 28. So this hits close to home for me, and I have been independently researching, for two decades now, strategies for reducing the risk of heart attack with diet.
Diet is vital for reducing your risk of heart disease, but unfortunately there is a fair amount of controversy around this topic. I have an upcoming video about what we would call the diet-heart hypothesis, and I will in the future share with you some “ancestral wisdom” that might be able to help you make good decisions about what to eat, keeping your heart-disease risk in mind.
