Why Do We Think High Cholesterol Causes Heart Disease?

by | Jul 7, 2014 | General Health

Well… doesn’t everybody know that?

Over thirty years ago in medical school I was taught this. For my entire career I have been instructed by my academic and medical superiors to be responsible for getting my patients’ cholesterol lower and ever lower in the interests of prevention of heart attack and stroke. I have learned to use an impressive and complex array of pharmaceuticals to address the issue.

But is cholesterol really the problem? Well, certainly, over a hundred years ago medical scientists studied the clogged arteries of those who had died from heart failure (“dropsy” as it was commonly called). They discovered at that a large portion of the substance within those blocked coronary arteries was cholesterol.

Now, many of these people had died from severe hypothyroidism, a condition called “myxedema”. When medical science learned that giving dried sheep or cow thyroid to patients fixed the thyroid deficiency, it was believed and widely practiced at that time that heart disease would also be prevented with thyroid replacement.

The thyroid connection with heart disease has been lost in the mists of time and all but forgotten as throughout the twentieth century more and more focus was placed on this cholesterol stuff as the cause of arterial disease. And why the focus?

Did I mention pharmaceuticals? Once it was shown that there was an association between lowering cholesterol and reduction in the rate of heart disease, and once it was shown that a class of drugs could lower cholesterol (the “statins”) the floodgates (should I say cash registers?) were open .  The intoxicating promise of lowering cholesterol in hopes of eliminating the atherosclerotic scourge on the health and longevity of mankind fueled an exciting and extraordinarily profitable industry.

The cholesterol-fighting business has built personal and public fortunes. It has funded educational foundations and public health initiatives. It has spurred major Madison Avenue marketing campaigns as giant food brands jockeyed each other for the “lower-your-cholesterol” championship and for prime real estate along grocery store shelves. It has built research wings of hospitals and, indeed, entire medical schools.

It is through teaching and research institutions and their collective push toward “evidence-based-medicine” that we doctors establish our peer-reviewed standards of practice. After all, didn’t double-blind placebo-controlled, university-sponsored studies show definitively that groups of men at risk who were treated with cholesterol-busting statins had lower rates of cardiac events than the untreated groups? And with such overwhelming academic, professional, and financial power directed at just this one thing is it any wonder that in the minds of most people (starting with doctors), the first thought in preventing heart attack and stroke is medications for cholesterol control?

But lowering cholesterol is not the best way.

Reducing weight, exercise, and blood pressure control are better (though much less profitable).

Common knowledge is commonly untrue.