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Posted on: October 1, 2018 at 1:36 pm
Last updated: October 30, 2018 at 9:53 am

Government recommendations and advice about cholesterol have shaped how and what people consume. And rightly so – those who are in power ought to look out for their people. For example, millions of people believe that blood levels of cholesterol are an early warning sign and, sometimes, cause of heart disease. So, naturally, you and countless others have gradually cut down cholesterol and saturated fat consumption.

These guidelines have also resulted in the skyrocketing use of statins, drugs that are supposed to lower cholesterol levels. You probably know them by popular names such as Lipitor, Zocor, and Mevacor. [1] However, the question of whether people (especially between the ages of 40 and 75) should take statins has been asked more and more. [2] This is mainly because research has debunked some saturated fat and cholesterol myths…

The Myths of Saturated Fat: Is It Good or Bad?

In the mid-to-late-1900s, there was a spike in heart disease throughout the United States. Although researchers theoretically knew that saturated fat could raise cholesterol, which is believed to cause heart disease, they assumed that saturated fat, therefore, caused heart disease… without conducting proper scientific human studies. [3] Now, there have been massive studies completed within the last few years highly suggesting that people do not have to worry about saturated fat as much as they thought. Here’s why…

A 2015 meta-analysis published in the British Medical Journal looked at 73 studies which included 90,500 to 339,000 participants to find out if there was an association between saturated fat and heart disease. [4] Researchers also looked at the likelihood of stroke, type 2 diabetes and death as a result of CVD. When compared against people who ate less saturated fat, those who ate more were not more likely to experience heart disease or any of the other health conditions listed above.

Another 2015 study published in the Cochrane Database of Systematic Reviews found the same results! [5] According to Healthline’s Adda Bjarnadottir, “it is probably the best review you can find on this at the moment, and includes 15 randomized controlled trials with over 59,000 participants.” [6]

In every study, which lasted for at least two years, people either reduced their saturated fat intake or replaced it with another types of fat altogether. Again, researchers found that participants who reduced their saturated fat intake were just as likely to get heart attacks or strokes, or die as those who ate more.

There are more studies like the ones above and people are aware of them… which is largely why many are no longer phased when it come to consuming saturated fats. [7] However, hearing about LDL or “bad” cholesterol still leaves a bad taste in many people’s mouths, [8] and a recent study just added to the controversy…

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Is Everything We Thought We Knew About Cholesterol Wrong?

At first glance, the title of the August 2018 study published in the Expert Review of Clinical Pharmacology may come as a shock – “LDL-C Does Not Cause Cardiovascular Disease.” Yes, that’s LDL, the type that is widely considered unhealthy or “bad” and can CVD. Moreover, the researchers also suggest “that statin treatment, in particular when used as primary prevention, is of doubtful benefit.” [9]

The study comes as a response to three recent papers published by statin advocates claiming that these drugs are more beneficial than harmful. In it, researchers attempt to prove them wrong.

1) Does High Cholesterol Cause Atherosclerosis (Plaque Build-Up in Arteries)?

The study’s lead author, Uffe Ravnskov, claims that if total cholesterol (i.e., both good and bad) does cause atherosclerosis, then more people with that condition should suffer from artery plaque build-up. But some studies only studied patients who were admitted to a hospital. So, compared to the general population, the results would most likely (and biasedly) include a higher number of people with both high total cholesterol and atherosclerosis. [9]

2) Does High Cholesterol Cause Cardiovascular Disease?

To combat this claim, researchers cited a 2004 Austrian study which followed 67,413 men and 82,237 women for many years. They found that “[total cholesterol] was weakly associated with coronary heart disease mortality for men” and basically absent among women. [9]

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3) Does High LDL Cholesterol Cause Heart Disease?

It seems logical that high levels of bad cholesterol should impact health and life expectancy more than people with low levels. However, researchers cited a systematic review of 19 cohort studies. Analyzing more than 68,000 elderly people, they found that those with high LDL cholesterol actually lived longer than those were being treated with statins. [9]

4) Does CVD Mortality Decrease After Statin Treatments?

We’re sure in some cases the use of statins has helped prevent heart attacks. However, CVD mortality has been decreasing around the world, all while statin use has increased and LDL levels have been falling… which makes it seem like statins have helped… But, according to a Swedish study that spanned 289 municipalities, “no association was found between statin use and the change in mortality from acute myocardial infarction,” otherwise known as a heart attack. [9]

Why You Should Still Take Their Claims with a Grain of Salt

Everyone has a bias, scientists included. Uffe Ravnskov, in particular, has long questioned the validity of the “Lipid Hypothesis,” the medical theory maintaining that heart disease and blood cholesterol are inextricably linked. [10] (And he has published numerous studies in attempts to debunk it.) [11]

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The study also had some inherent limitations, one being the fact that it’s a “narrative review,” which makes it more prone to bias, unlike a systematic review or meta-analysis that was mentioned earlier about saturated fat. For Ravnskov’s findings to be stronger, it would have been more helpful to reference other researchers who have arrived at similar results. Because every time there is a study disproving the cholesterol-heart disease link, there is one proving it.

There are also many other risk factors that affect one’s risk of heart disease including, diabetes, elevated levels of the lesser-known lipoprotein A, and high triglycerides. [12-14] What you need to do is be aware that the research is on-going and, when it comes to an individual’s lifestyle, there is no cookie cutter fix for cholesterol and/or heart disease.

What Does This All Mean?

Contrary to popular claims, Ravnskov and his research team believe that LDL cholesterol does not cause heart disease. That said, this “bad” cholesterol doesn’t necessarily prevent it either. So, what is needed for a heart-healthy diet? If you’re someone who wants to avoid statins, you will have to start exploring physical activity routines and pro-heart foods! In any case, balance is key and we have some fantastic articles to help you find it:

  1. 12 Foods to Avoid Heart Disease and Atherosclerosis
  2. 10 Foods You Should Eat Every Day for Clean Arteries

[1] Statins – Questions and Answers. (n.d.). Retrieved from https://www.cbc.ca/natureofthings/features/statins-question-and-answers

[2] Nedelman, M. (2018, January 01). Should you take statins? Guidelines differ. Retrieved from https://www.cnn.com/2017/04/18/health/statins-guidelines-conflict-study/index.html

[3] Gunnars, K. (n.d.). Saturated Fat: Good or Bad? Retrieved from https://www.healthline.com/nutrition/saturated-fat-good-or-bad

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[4] De, R. J., Mente, A., Maroleanu, A., Cozma, A. I., Ha, V., Kishibe, T., . . . Anand, S. S. (2015, August 11). Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: Systematic review and meta-analysis of observational studies. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26268692

[5] Hooper, L., Martin, N., Abdelhamid, A., & Davey, G. (2015, June 10). Reduction in saturated fat intake for cardiovascular disease. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26068959

[6] Bjarnadottir, A. (n.d.). 5 Studies on Saturated Fat — Time to Retire the Myth? Retrieved from https://www.healthline.com/nutrition/5-studies-on-saturated-fat

[7] McDonell, K. (n.d.). Why Dietary Cholesterol Does Not Matter (for most people). Retrieved from https://www.healthline.com/nutrition/dietary-cholesterol-does-not-matter

[8] (n.d.). Retrieved from https://www.medscape.com/viewarticle/879731

[9] Ravnskov, U. (n.d.). LDL-C Does Not Cause Cardiovascular Disease: A comprehensive review of current literature. Retrieved from https://www.tandfonline.com/doi/full/10.1080/17512433.2018.1519391

[10] The Cholesterol Myths. (n.d.). Retrieved from http://www.ravnskov.nu/cholesterol/

[11] Ravnskov, U. (2008, August). The fallacies of the lipid hypothesis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18615352

[12] F., A., B., G., N., H., G., I., . . . Packard. (2017, April 24). Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel | European Heart Journal | Oxford Academic. Retrieved from https://academic.oup.com/eurheartj/article/38/32/2459/3745109

[13] V., R., M, R., A., L., L, S., . . . G, E. S. (2018, June 21). Cardiovascular disease risk associated with elevated lipoprotein(a) attenuates at low low-density lipoprotein cholesterol levels in a primary prevention setting | European Heart Journal | Oxford Academic. Retrieved from https://academic.oup.com/eurheartj/article-abstract/39/27/2589/5042194?redirectedFrom=fulltext

[14] Chang, J. S., Zhang, Y., Kizer, J. R., Best, L. G., & Howard, B. V. (2017, April 01). Triglyceride and HDL-C Dyslipidemia and Risks of Coronary Heart Disease and Ischemic Stroke by Glycemic Dysregulation Status: The Strong Heart Study. Retrieved from http://care.diabetesjournals.org/content/40/4/529

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