I have deep concerns about the widespread use of statins and an even deeper skepticism regarding the logic from which they are prescribed.  The basic theory goes like this: cholesterol comes from your diet and your body makes it, misbehaving cholesterol clogs your arteries, clogged arteries leads to heart attacks, strokes, and ultimately an untimely death.  

Enter the alleged hero of this tale – the statin drug.  Effectively blocking your body’s ability to produce cholesterol, statins are reported to have saved thousands of lives and are so safe and effective that there has been some suggestion in jest that we should dump a steady stream of statins into the water supply.  It is worth dissecting this theory, known as lipid hypothesis, into its individual parts and contrast the science with logic and tradition.

To begin, every person walking the planet manufactures cholesterol; you can rest assured that our bodies are not trying to kill us.  Cholesterol is a building block and hormonal precursor.  Cell membranes are abundant with cholesterol which defines their shape and role in isolating the cell contents.  All of your steroid hormones, including cortisol, testosterone, estrogen, and progesterone, get their start with cholesterol as the building block.  Knowing this, the argument is not about cholesterol per say but an apparently insidious form that clogs arteries causing heart disease.  Lipid science has come a long way from LDL “bad” and HDL “good” because we can very precisely measure particle number and density of the LDL molecule that is associated with heart disease.  This last point is critical as it is not cholesterol itself, but what causes these numerous, small and dense cholesterol particles to become oxidized which is part of the pathology of heart disease.  More on that in a moment.

The plot thickens when the medical reporting shows us that heart attacks themselves do not necessarily come from those with high cholesterol.  Many emergency room visits for heart attacks come from those with “normal” cholesterol levels.  This fact alone should give us pause and encourage us to understand the underlying stressor compromising heart function.

For one, we know that the first step in the heart disease process is inflammation and hardening within the heart vasculature.  Over time, cell damage leads to a weakening of the arterial cells walls feeding blood to the heart.  Due to the high amount of pressure exerted on these arterial walls, your body will play contractor and smooth out any rough and damaged tissue within these very important thoroughfares.  This buildup of plaque (oxidized cholesterol) will bolster the vessel in the short term (preventing rupture) at the expense of your long-term mortality (arterial occlusion).  What ultimately can happen in this over exuberant patchwork is either a complete blockage or a piece of the clot can break off and occlude the artery feeding the heart leading to the ischemic damage we know as a heart attack.  In this scenario, blaming cholesterol for the plaque buildup is likened to condemning an ambulance arriving at the scene of a car crash for the accident.

Next question, does this oxidized cholesterol come from eating saturated fats?  The answer is a resounding no.  The connection between eating saturated fats and heart disease is a hypothesis and has never been proven; in fact all evidence seems to point to the contrary.  There are dietary triggers to the formation of oxidized cholesterol, which we will explore, but it is not from eating saturated fats. 

If we combine the facts that cholesterol is essential for growth and development, and that oxidized cholesterol is a factor behind the cause of heart disease, the use of statins begins to look shady at best, band-aiding a problem that has not been fully addressed and complicating the picture by adding a whole host of side-effects that can, ironically, weaken the heart itself.  Stay tuned for the next installment for an explanation.


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