It’s pretty well established that, despite drug companies mounting a massive push and “educational” effort for years, total cholesterol by itself has little to do with heart disease rates.
However, I still have to educate people in the community and my practice on this little tidbit. The focus away from total cholesterol was made quietly, most likely as an effort to save face by those who had been pushing cholesterol levels as THE answer to heart disease.
The research on HDL (the “good” cholesterol), LDL (the “bad” cholesterol), VLDL (the “worst of the worst”) and triglycerides, however, is stronger.
In my opinion, the HDL:triglyceride ratio is the most valuable, but overall it’s the entire picture painted by all the lipids that give us the best picture. This viewpoint, however, is not what drug research and use is about. Since drugs can usually only affect one blood value at a time (i.e. statins will lower LDL but won’t have a big impact on triglycerides), researchers have to push hard to find a relationship between a value and a disease (such as total cholesterol and heart disease) and then find a drug that affects that value.
Miraculously, despite all my Rantings on cholesterol lowering drugs as well as an eBook on cholesterol lowering drugs, I still have patients come in who think that the drugs they’re on will actually protect them from heart disease and stroke. Needless to say, I’m not a fan of cholesterol lowering medication and will not hesitate to point out the research related to cholesterol.
Which leads me into this particular study. In it, researchers looked at two types of lipids, HDL cholesterol and apoA-1. Most know that HDL is generally considered the “good” cholesterol and lifestyles that promote higher levels will be strongly protective against heart disease and stroke. ApoA-1, however, is less well-known. Apolipoprotein A-1 is one of the major proteins that makes up the HDL molecule and helps to shuttle cholesterol around the bloodstream. Having higher levels is more protective to the heart.
This study looked at the effect that HDL and ApoA-1 levels had on heart disease. Then, they looked at what effect statins had on these relationships. Here’s the specifics:
- HDL lowered the risk of a major cardiovascular event by 17%,
- ApoA-I level lowered risk 21%.
- In those patients taking statins whose LDL cholesterol levels were lowered to at least 50 mg/dL, an increase of HDL-C did not lower heart disease risk.
- However, in the statin responders, a rise in apoA-I did lower the risk of heart disease by 7%.
So what does this mean? Higher levels of HDL and ApoA-1 are good for your heart. But when those levels are artificially raised by a cholesterol lowering drug, it either didn’t help at all or the benefit was far less than higher levels occurring naturally.
When we find, from observational studies, that some lab value protects against some disease, it is LIFESTYLE that gives the benefit. Cheating by using drugs to lower the value, if it works and doesn’t kill you from the side effects, will never produce the same benefit.