Cardiologist Speaks Out Against Current Cholesterol Guidelines

| May 8, 2012

Most medical professionals strongly believe that cholesterol causes heart disease and that treating ‘raised’ cholesterol and bringing it down to a so-called ‘healthy’ level is beneficial for us all. However, I’ve been sceptical about both these ideas for many years now.

I’m not the only one, though, as quite a few individuals have expressed similar doubts about the ‘cholesterol hypothesis’. Because the cholesterol hypothesis is so firmly entrenched in so many people’s minds, and because dissenters are often from the fringes of (or outside) mainstream medicine, any scepticism is relatively easy to dismiss. I think. However, when someone from within the establishment expresses doubts, the impact can be that much greater.

And that’s why I was very interested to read an open letter expressing doubt about the wisdom of current cholesterol management strategies, co-authored by Harlan Krumholz, professor of medicine and cardiologist at the Yale University School of Medicine. The letter, which appeared in the journal Circulation [1], was written to the Adult Treatment Panel – a group of ‘experts’ charged with setting guidelines for the American public.

The panel is due to issue new guidelines later this year, and the chances are it will recommend that we keep strong downward pressure on our cholesterol numbers. But not all individuals in the medical and scientific community agree with this approach, and one such dissenter is Professor Krumholz. In the letter, Professor Krumholz and his co-author highlight what I believe to be 3 very important points:

1. There is no scientific basis to support treating to LDL targets

Current recommendations are for people to lower their supposedly unhealthy LDL to a certain level. The problem is, no study has actually tested the benefits of this specific strategy. Professor Krumholz points out that there are many instances where cholesterol reduction has not translated into clinical benefits (e.g. reduced risk of heart disease or death). Actually, all the positive effects of cholesterol reduction appear to be limited to statins. The thing is, though, statins don’t just reduce cholesterol, they have other effects including an anti-inflammatory effect. What this means, in essence, is that the apparent benefits of statins may not be down to their impact on blood fats, but other effects that have nothing to do with cholesterol.

He also points out that the benefits of statins do not appear to be very related to a person’s LDL levels before treatment. In other words, those with higher LDL do not benefit more than those with lower levels. This again points to the fact that statins probably do not work through cholesterol reduction. In the end, though, as Professor Krumholz points out, it does not matter whether LDL causes heart disease or not. What matters is that LDL levels are actually quite a poor predictor of someone’s risk, and therefore basing treatment decisions on LDL levels does not make sense.

2. The safety of treating to LDL targets has never been proven

So, we know that there’s no scientific basis to treating to a particular LDL level, but Professor Krumholz then goes on to point out that the safety of this practice is not established either. While there is quite a lot of evidence for the relative safety of statins, data in the long term is lacking, as is data on most other cholesterol-reducing agents. Some claim the very fact that cholesterol is being lowered should give us confidence that the benefits will outweigh any harm. However, as Professor Krumholz points out, we have instances where basing treatment decisions on ‘surrogate markers’ has led to harm. He cites examples of where aggressive treatment of diabetes and blood pressure has done more harm than good.

3. Tailored treatment is a simpler, safer, more effective, more evidence-based approach

Professor Krumholz makes the point here that current treatment strategies are inefficient, and that treatment decisions should not be made on the basis of cholesterol levels, but a person’s overall risk of cardiovascular disease. This more holistic approach, by the way, will likely see many people suddenly not ‘needing’ statins or other cholesterol treatments after all, like practically every one of the relatively young, fit, healthy, non-smoking men or women who have turned up a ‘raised’ cholesterol on blood testing.

I don’t expect Professor Krumholz’s views to go down a storm with the medical community and certainly not the drug companies. But I think he should be applauded for standing up and telling what he believes is the truth, even if this flies in the face of conventional ‘wisdom’.

Here’s to a healthy heart

Dr John Briffa
Editor
for The Cholesterol Truth



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Bear in mind we are not addressing anyone’s personal situation and you should rely on this for informational purposes only. Please consult with your own physician before acting on any recommendations contained herein.


References:

1. Hayward RA, Krumholz HM. Three reasons to abandon low-density lipoprotein targets: an open letter to the Adult Treatment Panel IV of the National Institutes of Health. Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):2-5.

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Category: Latest Cholesterol News, The Great Cholesterol Con

Comments (4)

Testimonials are based on the personal experience of individuals. Results are not typical and the potential benefits of taking any drug or supplement may vary depending on your individual needs and health requirements. Please consult your GP before making any changes to your medical regimen.

  1. Nick says:

    I think there are many doctors who’d like to speak out against these drugs but they are fearing losing their careers if they do. Not all doctors are bad.

  2. Thomas Martin says:

    After nearly dying at age 50 from heart failure, I decided I needed to take matters into my own hands when my cardiologist couldn’t give me a reason for my heart problem. I read obsessively and found that most of what we have all be told about heart disease is a lie. I embarked on my own path, seeking alternative doctors. I did require LVAD (left ventricular assist device) surgery to halt my decline, but I continued on my path and despite being given odds of 99 to 1 against my getting well, my heart did heal and the device was removed. I have written about my journey, lessons learned and the path I took to health in “One Percent: My Journey Overcoming Heart Disease.” Your health is your responsibility. Don’t turn your life over to the medical machine.

  3. Cholesterol Truth says:

    Unfortunately, one study, cannot dispel the numerous studies that have shown the detrimental effects taking statins… A blanket approach, which is suggested in The Lancet, is not only misleading but wholly irresponsible especially if you consider that they suggest giving statins to healthy individuals… which in effect means that a perfectly healthy individual will take a drug that causes myopathy, liver damage, kidney damage and increases the risk of cancer… It makes no sense.

  4. Mark Nicholls says:

    I wonder what you make of the latest report in The Lancet which seems quite unequivocal in asserting the benefits of statin use for everyone over 50 whether at risk of cardiac disease or not? http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960367-5

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