Assessing your risk of heart disease and why cholesterol lowering drugs will have a negligible effect on decreasing your risk
There are ways to look at your standard lab cholesterol tests and determine the types of LDL particles in your blood. However it must also be noted that lipid results should always be examined in the context of a persons diet and lifestyle. At the end of the day those lipid results are just markers and we are treating the person, not their cholesterol levels.
We know that 90% of heart disease is driven by diet and lifestyle factors. Therefore, “bad” lipid markers in the context of an unhealthy diet and lifestyle will increase the risk of heart disease.
If a person smokes, drinks a lot, doesn’t exercise much, has a poor diet, stresses a lot, doesn’t get adequate amounts of sleep and has a family history of HD, they are at a greater risk of a cardiovascular event compared to someone that may or may not have a family history but lives healthy diet and lifestyle.
Furthermore, we know that these poor diet and lifestyle habits increase the amount of small LDL (cars), decrease large LDL 9busses) and decreases LDL receptor function (parking spaces), hence increasing the risk of HD. Where as good diet and lifestyle habits increase the amount of busses and increases parking spaces (even if passenger numbers increase or stay the same).
When a doctor looks at your bloods tests they mainly look at your total cholesterol, LDL and triglycerides.
NOTE: Think of triglycerides as luggage in the cars or busses. The more luggage there is, the more vehicles there will have to be. Triglycerides increase due to being overweight, having poor insulin sensitivity and high consumption of processed foods.
Doctors will prescribe cholesterol-lowering drugs if your LDL and total cholesterol levels are high, with little investigation into your diet and lifestyle, despite good HDL levels and whether or not these LDL are big or small.
Therefore, a person may have high cholesterol and LDL but all the cholesterol is in busses and their diet and lifestyle is good, therefore the HD risk will be low. Hence a statin should not be prescribed, as these drugs are not harmless.
Even if someone has high cholesterol and LDL levels, which may be in the form of small particles, it is unlikely that statins will protect them from a cardiovascular event anyway.
Statin prescriptions are on the rise due to the HD epidemic, however this hasn’t changed heart disease rates. One would think that if stains are effective, increased prescriptions based on high cholesterol levels, would lower heart disease rates, but this is not the case. Increased statin prescriptions has not prevented HD rates. This is because as mentioned above, HD is mainly a diet and lifestyle disease, and while genetic factors play a small role, they will only manifest themselves in the backdrop of a poor diet and lifestyle. Statin use is not going to change someones unhealthy habits.
Therefore the prescription of a statin, without diet and lifestyle interventions, is basically pointless. Stains will decrease the amount of passengers (decreases cholesterol from the liver) on the road, but it will have a negligible effect on the amount of cars on the road and no effect on parking space. This means that statins don’t change the amount of LDL floating in the blood, it may just reduce passengers.
Diet and lifestyle factors are much stronger risk factors for HD than cholesterol levels, which is why lipid results must always be interpreted in the context of a persons diet and lifestyle. There is an association between increased LDL and HD. However, this is usually if the LDL represents mostly cars and not busses, which is determined by your diet and lifestyle anyway.
Lastly, as mentioned above, while there is little evidence to say that statins prevent HD based on high cholesterol levels, there is some evidence to say that if a person has already suffered a cardiovascular event, statins may decrease the risk of reoccurrence. This is mainly shown in men over the age of 60.
How to interpret your blood test to assess your heart disease risk
So lets talk a little bit more about interpreting blood tests to determine if you have cars or busses in your blood.
Recent research has shown that if you divide your LDL by your HDL, your total cholesterol by your HDL and your triglycerides by your HDL, this will give values that are more indicative of heart disease risk as they give insight into the size of your LDL particles. Ultimately you want all these values to sit below 3.8. And as you can see, within all these equations HDL is the denominator. So if HDL (commonly known as the “good cholesterol”) is high, it will keep the ratio low. Even if total cholesterol, LDL and triglycerides are high. So we can think of HDL as also being busses that help to transport passengers back to their home, after they have gone to their destination. As mentioned above, HDL take cholesterol back to the liver and clears the blood of cholesterol. Good diet and lifestyle habits increase HDL. Increases in HDL with increases in HDL cancel each other out.
In the conventional medical realm, there is emphasis put on HDL levels, however doctors will normally prescribe statins based on LDL, triglycerides and total cholesterol. This is despite your levels of HDL and the ratios.
Yes the paradigm is slowly shifting, but it is still taking time and most doctors will want your LDL and total as low as possible and they will do this with medication. While having a lack of regard for the importance of cholesterol’s functions in the body.
Which brings me to my next point, that lowering cholesterol to very low levels can increase the risk of many other health issues, which is why stains carry so many side effects.
Because of the high amounts of cholesterol in the brain, low levels and chronic statin use can lead to (and exacerbate) depression, anxiety and other mood issues, as well as dementia. It can decrease vitamin D levels, therefore increasing the risk of many health issues associated with vitamin D deficiency such as osteoporosis, diabetes and HD! Cholesterols role in sex hormone production can lead to a vast array of issues associated with low sex hormones.
Lastly, statins also increase the risk of diabetes, which is one of the strongest risk factors for developing HD.
Wrapping it up
Hopefully in the near future enough studies will be published to convince the medical model to change the way we address HD because as you can see, it is a diet and lifestyle disease, therefore the treatment requires diet and lifestyle interventions.
While most people know they need to change their diet and lifestyle, they often don’t know HOW, which is why health practitioners need to start helping patients at risk of HD to facilitate behavior change.
After reading this three part series, I highly recommended you find a practitioner who is willing to work alongside you to change aspects of your diet and lifestyle that you may lack consistency around, such as your diet, sleep, stress levels, exercise, smoking and alcohol consumption.