Tuesday, February 5, 2008

Prevention, Wellness - Cholesterol Conundrum: Call for Comments

The word “cholesterol” gibbered through the land as the word “unclean” used to herald the approach of a leper. There was a tremendous to-do about the lethal snags created in the bloodstream by carbohydrates and animal fats, either separately or in combination. Cholesterol was as fatal as slit along the riverbed and was responsible for most of the heart attacks and strokes of what was called successful men.

Alistair Cooke, The Patient Has The Floor. Alfred A. Knopf, 1986


Cooke’s words came to mind last week on two occasions.

One, while sitting around drinking coffee with 12 male friend of a certain age. Ten of the 12 were taking statins to lower their LDL, and all knew their precise cholesterol “number,” which in all hovered below the magic number of 200.

Two, while reading a NYT times Op-Ed Piece “What’s Cholesterol Got to Do With It?” The author, Gary Taubes, author of a book Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease had the audacity to say cholesterol and LDL-cholesterol had little, if anything to do, with heart disease. This assertion opened up a can of worms in the form of a spate of letters to the editor. Here are some typical excerpts.

• From a cardiologist from Tufts, “ Twenty years of research describing hundreds of thousands of patient-years has unequivocally proven that lowering of LDL eventuates in reduced mortality as well as significant reductions in the likelihood of suffering a heart attack, stroke, or the need of surgery.”

• From a “medical doctor” in Brookline, “After reading Gary Taubes’ article I quickly realized that the myth of the relationship between low-density lipoproteins and heart disease was but another example of Sir William Osler’s aphorism, “the greater the ignorance, the greater the dogmatism.”

As a clinical pathologist, I used to write algorithms and give advice on how to interpret the various lipoprotein types. I’m no longer in the advisory game, but when I was, I observed the follow.

• Total serum cholesterol is not a static or stable number. I had my own blood drawn daily over the course of two weeks, and my serum cholesterol varied by +/- 20 points.

• Serum cholesterol and LDL can be misleading predictors of coronary artery disease. I question the wisdom of placing people with type II familial hypercholesterolemia on statins. These patients are not necessarily at risk for heart disease, yet they are routinely placed on statins when cholesterol or LDL exceed 200 or 100.

• Also I wonder how clinicians out there treat the so-called metabolic syndrome, which is characterized by a normal cholesterol, high triglycerides, and low HDL.

I doubt if anything doctors do will alter the public’s belief that elevated cholesterol and LDL have everything to do with it.

Your comments, please, on the LDL, total cholesterol conundrum.

76 comments:

David Brown said...

Hi Richard,

Where do I start? I've been studying nutrition for 30 years and for at least 25 of those years, I fully expected the cholesterol hypothesis be discarded. So I'm upset. Not so much at government agencies for allowing corporate interests and vegetarian activists to dictate dietary guidelines or at corporations for protecting their interests. Rather, I'm disgusted with academia for not using science properly. There's something dreadfully wrong with a system that cannot correct itself in a reasonable amount of time.

Our best hope at this point is for consumers to educate themselves and their neighbors (which indeed, they are doing) through forums, blogs, newsletters, and websites.

David Brown
Nutrition Education Project

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