by Ross Walker
Cholesterol and saturated fat have been demonised by conservative medicine for the last fifty years as evil poisons that clog arteries. Statin drugs have emerged over the last thirty years as miracle solutions to prevent heart disease. The recent Catalyst program run on ABC television over the last two Thursdays presented brilliantly by Dr Maryanne Demasi, has certainly set the “cat amongst the pigeons” and has called into question all of the above comments.
Some conservative health authorities actually suggested to the ABC that if they ran this show on television and induced many people to stop their statins, that they would be responsible for many deaths in the Australian community.
The general public has all right to be confused and to start questioning, what is the real truth? As the person who suggested to Maryanne Demasi a few years back that she should look into this issue, I feel very responsible for the message that has emerged and feel that I should state my position very clearly.
The Real Science behind “the Heart of the Matter”
Firstly and most importantly, there is minimal link between total cholesterol levels and cardiovascular disease and cardiovascular risk. There is a small subgroup of people living in our society who suffer a condition known as “familial hypercholesterolaemia”, where the cholesterol runs between 7-10, regardless of diet and this is in fact a liver disease, where the liver cannot metabolise LDL cholesterol properly. Thus, these people have very high cholesterol levels and do indeed have a high rate of vascular disease. Sufferers of familial hypercholesterolaemia have about a 50% risk by age fifty of having some sort of vascular event, such as a heart attack. If you do not suffer familial hypercholesterolaemia, as I initially stated, there is little relationship between high total cholesterol levels and cardiovascular risk.
Secondly, when one discusses bad fats, it is rather spurious to demonise natural fats. Saturated fat is natural fat found in animal products and again there is little relationship between saturated fat intake and cardiovascular disease and risk. For example, last year, a study was released that showed no relationship between the intake of natural fats and cardiovascular disease but a 40% increase risk for cardiovascular disease in people who ingested a significant amount of delicatessen meats, bacon and sausages.
Another very common misconception is that LDL cholesterol is the bad cholesterol and HDL cholesterol is the good cholesterol. This is in fact not the case. Both LDL and HDL are divided into large and small components. The small component of LDL is the part of the LDL molecule that does get into the arteries and set up fatty plaques. When you measure total cholesterol, however, most of that is the large LDL which in fact has significant benefits I will detail in a moment.
The small component of HDL is pro-inflammatory i.e. it promotes chronic inflammation that is related to many diseases such as heart disease, diabetes, cancer and even Alzheimer’s disease. The large component of HDL however is antiâ€‘inflammatory and also removes fat from the arteries.
The large component of LDL is the basic protein that delivers the vital components of cholesterol to cell membranes, for cell communication, is used as the basic steroid ring for many of our hormones and is also intermittently involved in bile salt and vitamin D metabolism.
Despite the obsession with having cholesterol levels checked by the medical profession throughout the world, not many people in Australia have their small and large subfractions of LDL and HDL measured. It is moderately expensive and is certainly outside of Medicare.
This brings us to the statin drugs such as Lipitor, Crestor, Zocor and Pravachol. Lipitor is the biggest selling drug in the world and along with its partner in crime Zocor, is a fat soluble statin and as a Cardiologist, I do not use fat soluble statins. I must state right now that my views are not shared by the vast majority of my colleagues in this matter. I only use the water soluble statins Crestor and Pravachol because I believe they penetrate less into the tissues and overall have less side effects when used at moderate doses. Interestingly, however, statin drugs have little affect on lowering the bad subfractions i.e. small LDL and small HDL. Statin drugs also are renowned for causing side effects and anywhere between 10-20% of people who take statins get muscle pain, stiffness, weakness and atrophy along with around 20% of people getting problems with memory, concentration, depression, fatigue, anxiety, irritability and they don’t sleep well. There are some reported effects on the liver and anywhere between a 10-50% increase risk for diabetes depending on the group studied.
The drugs that do positively affect the cholesterol subfractions are less commonly used and include the fibrate drugs, the most prominent being Lipidil, an old style drug known as Nicotinic Acid and a supplement that I use as a routine known as “BergaMet”. BergaMet is a natural substance that comes from Calabrian oranges and not only shifts you from small LDL and HDL to large LDL and HDL (with often not much effect on the total cholesterol levels) but also lowers the sugar, the blood pressure and makes it easier to lose belly fat.
I believe the most important point in the entire debate is that doctors should not be treating cholesterol levels but rather treating coronary risk. I have developed in my own practice as a Cardiologist, a coronary risk calculator which includes what is known as “Framingham risk, Reynolds risk and coronary calcium scoring and gives a very accurate ten year risk percentage. I regularly assess people and suggest that all males at fifty and all females at sixty who are asymptomatic with no prior history of heart disease, have a coronary calcium score which is the most accurate predictor of coronary risk especially when incorporated into the ten year coronary risk calculation that I have just mentioned.
If you have a strong risk factor profile for heart disease i.e. a cholesterol abnormality, high blood pressure, cigarette smoking, diabetes or a tendency to diabetes or a family history of a close relative who has suffered some form of heart disease or stroke before age sixty, then you should probably be tested earlier.
The coronary calcium score is a snapshot of your arteries using a CT scan. It does not involve an injection or any dye and if the radiology practice comes at you with a needle, I would suggest you ask them not to do so.
It is my opinion that statins should be a small part of the risk factor management in firstly, all patients with established vascular disease i.e. prior heart attack, stent, bypass, stroke or some other vascular equivalent or if they have a high atherosclerotic load, as seen with a high coronary calcium score.
Finally, taking a statin drug reduces your risk for a cardiac event such as a heart attack by around 20-30% when using average doses of the drugs. A recent study out of Holland has clearly shown:
Then you reduce your risk for cardiovascular death by 83% and all cardiovascular disease by 65%, obviously with no side effects.
If you would like more information on this subject, please do not hesitate to email me at firstname.lastname@example.org and if you would like to obtain BergaMet go to www.bergamet.com.
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