Does ‘Good Cholesterol’ Really Help Prevent Heart Attacks?
A paper in the Lancet for May 17 illustrates several important features of medical science, and modern medical science in particular. First, its collaborative nature: There were 127 named authors of the paper, from 69 centers of research around the world (if I counted correctly). Second, its power to challenge received ideas: The paper raises severe doubts whether “good” cholesterol, as it is popularly known, really protects against cardiovascular disease, as many a patient must have hoped. And third, it is a powerful reminder of what is often forgotten, no matter how many times it reiterated, that correlation is not the same as causation.
Concentrations of high- and low-density lipoproteins (HDL and LDL) in the blood were supposed to have opposite effects on the patient’s risk of developing cardiovascular disease, and both were also supposed to be causative. A high level of LDL (“bad” cholesterol) predisposed causatively to such disease; a high HDL (“good cholesterol”) protected against it, also causatively. You hear people discuss their levels with one another on buses and other public places.
The paper casts doubt on the second of the propositions, the protective effect of high HDL. It is true that people in a population with high HDLs are less likely to get heart attacks than people with low levels; but this does not prove that the relationship is fortuitous, rather like that between big feet and high intelligence.
The authors found a large number of people who had a genetic variant that gave them a high HDL level. If the causative hypothesis were correct, this would mean that they would have a low rate of heart attacks, but they didn’t. The authors worked out that those with the genetic variant ought to have had a rate of heart attack 13 percent lower than controls, if the statistical association noted in previous observational studies were a causative one. Instead, their rate of heart attacks was precisely that of the control subjects who did not have high HDL levels. This suggests that having a high HDL is not causatively protective against heart attacks.
Why is this important?
Is this the same Lancet that gave the 655,000 Iraqi deaths the left loves to quote?
But the Science is settled. There is a consensus among the vast majority of doctors that “good” cholesterol prevents heart disease.
Theses Deniers must silenced or millions will die!!!
Not only is it the same Lancet that shamelessly inflated Iraqi war deaths for purely political ends, this is the same Lancet that published Wakefield’s study linking vaccines and autism. They’ve retracted it, of course, but by the sheer number of deaths, it’s still the biggest case of editorial and medical malpractice in my lifetime.
I honestly don’t understand it. Their false reporting was the basis of a movement that scares parents into not vaccinating their children against horrific diseases, and people *still* read them. Is there anything they can write that would cause people to say, “enough, these guys have traded their reputation for big headlines one too many times.”
The ratio of LDL and HDL is not really the issue. It is the level of small LDL particles in the blood stream that is the issue. High levels of small particles in the blood stream are a indication of bad dietary eating habits. Mainly the ingestion of wheat and other grains. Read “Wheat belly, by Dr. William Davis MD”.
With an HDL of 52 and an LDL of 69, I thought I would live forever, but I guess not now and I had better make out my will.
My understanding is that the really bad thing is oxidized LDL. When LDL is oxidized, it can interact with the artery wall, being “sticky,” and blood clots can form thereon, precipitating a heart attack. How more HDL might prevent this oxidation, I don’t know.
Vitamin E is important in keeping LDL from oxidizing, so much so that if it were a new drug, it would be called a wonder.
in a meta-analysis of vitamin e dosages of 400 units were linked with congestive heart failure.
so much for a wonder drug
The first law of toxicology: the dose. Too much vitamin A, D, or K will hurt you too, yet no drug can substitute when a vitamin is deficient. B12 deficiency can mimic a lot of serious diseases.
Proper dose of vitamin E: http://www.drweil.com/drw/u/ART02813/facts-about-vitamin-e
Being a modern British organization I mistrust The Lancet at all levels.
The Lancet is a weekly peer-reviewed general medical journal, rated second only to the NEJM. I don’t read it, though I occasionally try to understand some of their technical articles. They don’t “report”; they publish medical studies and reports. I suspect that the Iraq death count was sent by a Doctor or medical team there, and it probably had some political content. The Editors probably found something in it of medical interest, justifying their prejudice in publishing it. Doctors rarely lean Right; occupational hazard.
Lancet has an Editorial page where opinion is posted. Whether the “death count” was in an article or an Editorial has to be understood for what it was. We shouldn’t denounce the publication, generally, but consider its medical value in posting the latest study data. The political stuff is just that, and should be taken for what it’s worth, basically zero.
Denis
A few years back (2008) there was a food product readily available at any big grocery store called Promise Activ “SUPER SHOTS”. It was located in the refrigerator section, near the yogurt shelves and then suddenly and unexplainably disappeared. This little shot sized yogurt type drink was full of phytosterols and stanols, and whatever the combination, it was dynamite for lowering overall cholesterol just by drinking one little shot per day.
Now, the very effective Promise Activ “Super Shots” is no longer available. You have to wonder about the and ways of big Pharma intervention! Must keep those high priced, side-effect-full experimental laboratory creations coming and yet Americans are sicker than ever. I’m sure the recipe for “super shots” is languishing on some dusty corporate shelf.
Anybody with a cholesterol problem should research for themselves and consider the phytosterol-stanol direction in conjunction with your current doctor directed regimen because it does work.
One paper or one clinical trial does not a truth make!
Consider ALL of the evidence not just one statement from the latest study/paper/trial. Even in a civil case the rule is ‘a preponderance of evidence’.
The press so wants to make a big deal about every schlocky statement or pseudo scientific finding. They are as or more guilty than the so-called researchers.
The preponderance of the evidence – the comments here posted – adequately demonstrates the hazards of non-medicos interpreting and responding to medical data. Legalisms and anti-Big Pharma fever, oxidation and vitaminology, all in just a few comments.
And it would seem the notion that high ratios of HDL to LDL reduces heart disease substantially, is an example of the hazard of medicos interpreting and responding to medical data.
Also the notion that salt in the diet causes high blood pressure generically–it doesn’t. That margarine is healthier than butter–drastically not true. Or the ludicrous notion that fat in the diet produces either fat on the belly or heart disease.
All fervently touted medically approved untruths–either at one time or even right now.
A point for you, Doctor, about the accuracy of medical professionals: if you remember, during the early 1970s, entire families were being recommended to replace butter with margarine, if there were possible tendencies towards cardiovascular disease in that family. Mine was one such. We faithfully followed the doctor’s instructions for many years.
To find out that they were dead-wrong, and margarine of the sort they’d been pushing was actually worse than butter.
So tell me…how many years have been shaved off of my life, all thanks to the stellar accuracy of physicians?
Scientific advancement works like this. First a thesis is proposed and tested. Then an anti-thesis or antithesis is proposed and tested. Then a synthesis is proposed and tested. Then……(You get the idea.)
News media works like this. THESIS!!!!! THESIS!!!!! THESIS!!!!! NO POSSIBILITY FOR ANTITHESIS!!!!!! THE END OF THE WORLD IS NEAR!!!!!! (which backs the news organ’s particular viewpoint or which because of oddity simply sells more newspapers.) It is precisely because of this mindset that the news media becomes entrenched in a particular idea and refuses to accept challenges to that idea. Global warming, as a thesis, comes to mind. Claims of unassailable scientific consensus on the matter and “The science is settled!” refuse to allow for the consideration of antithesis and ultimately, synthesis.
Dr. Dalrymple bravely reports findings that contradict medical dogma which he points-out is based on correlation of data. He refers to this correlation as “received knowledge” rather than “evidence”. For that he should be praised, IMO. The Cholesterol dogma is based on flimsy data based on the 1948 Framingham, MA “study”, which compiled health characteristics of a rather specific genetic population. Tabulating what they considered “risk factors”, their recommendations were laid on a very thin statistical foundation, yet they came-up with hard and fast rules for everyone’s lipid levels that, over all the years, never proved beneficial in preventing heart attacks. What the good Doctor reported, is generally not circulated because it is not “Medically P.C.”.
This link to a 2009 article by a highly respected UCLA Cardiologist provides unknown (“unreceived”) knowledge, and it generally is jaw-dropping to MD’s when they see it, as it contradicts the LDL (”bad cholesterol”) dogma, stating that people with Low or Excellent levels of LDL-C, have almost five times as many heart attacks as those with higher LDL levels:
http://news.health.com/2009/01/16/cholesterol-levels-may-not-measure-cardiac-risk/
These two reports essentially turn-on-its-head the Cholesterol heart disease dogma. Now that Pfizer’s Lipitor is off-patent and no longer being sold, the financial “assistance” that kept these “heretical” contradictory findings quiet, will be reduced, and more information will probably find its way to the public. Controlling Cholesterol with drugs will join “bleeding” patients as sad medical history.
Denis
For years we all read about the food pyramid and ate our carbs and greens and dairies.
One day I read some heretics theory about not eating carbs. Bam. Night and day – weigh loss, improved thinking, no more strange rashes. And still I read how someone statistically has proven that calorie count is the important factor.
Now by contrast in all my career there has never been any need to walk back Bernoulli’s principal, or Ohm’s law or Shannon’s law.
I think thats because unlike Nutrition, Engineering has the imperative of using theory yes, but as verified by experiment. Engineering in fact is results.
A lot of lay persons sometimes get the impression that the latest nutrition advice is always changing because there is not solid experimentation. How else can one kind of fat be bad, then good, then bad again? Were there ever experiments on apes that specifically fed them the exact kinds of fats and measured the results?
The one thesis that all studies unanimously support is that life itself is ultimately fatal.
Oh, how little we really know for certain. It was ever thus no matter how smart we always think we are.
Dr. Daniels: Does anyone know why atherosclerotic plaques form between the intima and the muscular layer of the arteries, rather in the lumen where the serum cholesterol is?
GPs who check their patients’ cholesterol levels have noted that those with extra high HDL usually drink much more alcohol than normal — more than is good for them. So if you’re getting your cholesterol checked, don’t try hiding how much you imbibe, because it won’t work.
Let’s get real here.The real culprit is inflammation,which causes atery walls to become rough and allow placque to stick and build up.Cholesterol by itself is slippery and will not cling to smooth artery walls that have not been roughened up by inflammation and poses no threat to healthy uninflamed arteries.Cholesterol is not the culprit and has never killed anybody. The real culprit is inflammation which can be easily be controlled and eliminated naturally by diet,and controlling ph levels in the blood without needless,harmful medications.ALL BY NATURE.
Exactly my experience. Type 2 diabetes millitus with hypertention. Brought on by excessive amounts of visceral fat. I got that fat by eating crap foisted upon me by listening to .gov and their friends who make loads of cash by selling us on the “benefits” of a whole grain diet with low fat. I kept trying to eat less and less and yet I could not lose weight. Within seven months of stopping the insanity I lost 70lbs and no longer have to take meds to control my glucose levels nor BP meds. No cardio intensive exercise or endless hours in the gym.
I say this not to keep people from seeing and working with their MD. I still see mine and every time I do, he is amazed by my blood work. I am still going to die in the end but my life will be better lived until then.
I used to worry about all the cholesterol numbers until I happened onto this:
http://www.ravnskov.nu/cholesterol.htm
The guy presents a heck of a case. At my workplace I know several people who have had terrible side effects from statin drugs. These ill effects are supposed to be “rare”, but I don’t think so. Ravnskov and others make the point that Big Pharma bankrolls an awful lot of the research on their drugs’ effectiveness, so color me skeptical.
Good points about statins and big pharma. I feel that the pharmaceutical companies really did think that statins would be a miracle drug and for some they have been but for others, like me, they are poison. I believe it takes years to fully assess a drug and its side effects and they all have side effects, some more benign than others.
Anyone who wants to improve their diet just needs to get as much sugar out of their diet as possible.
Good medicine is a combination of art and science. The human body is so complicated and varied, one size or one prescription does not fit all. That is why so many of these health prescriptions and fads eventually fall apart. The mistake is trying to fit everyone into one mold when it just can’t be done honestly.
I am also don’t put alot of credibility in the Lancet or its cousin the British Medical Journal. Their credibility has been hurt by dabbling in trendy British politics. As another commenter pointed out, the Lancet published the fatuous Iraqi death toll article which was an obvious fraud for anyone with a passing knowledge of statistics. They also routinely publish pieces bashing Israel for allegedly denying Palestinians health care, a charge that is also without basis. But they rely on the trendy prejudices and misplaced trust of their readership.
I’ve, for some time, been unconvinced that their formulas and ratios etc. could be applied without regard to the dietary heritage of the individual. Genetic composition of those that evolved in one area where grains and dairy were fundamental seemingly cannot be lumped in with a tropical/ocean centric society that evolved eating fish and fruit.
Yet, to my knowledge, doctors do not determine this evolutionary heritage and apply medical decisions specific to each.
It’s a demonstrated fact that if one eats foods full of the bad cholesterol for 80+ years, one will live 80+ years.
Seriously, since everyone has a unique physiology and medical journals generalize about billions of people, medical journals are of limited utility.
Watch Sleeper again. Woody Allen has foreseen it all.
What will I ever do with my Jack LaLanne Power Juicer?