Lipid Management

Cholesterol is probably the most controversial topic I get into with my patients. This is because many of them have heard that cholesterol drugs (statins) cause cancer, or deplete CoQ10, or don’t work, or are a waste of money. Recent scandals in the industry have not helped either. Many of you reading this book have also heard that cholesterol doesn’t cause heart disease. I’ll discuss why there is some truth to these myths but also help you understand why and how statin drugs help reverse your trajectory toward a heart attack. I’ll also talk about nutritional strategies for improving cholesterol numbers.

Low-density lipoprotein (LDL) is the “bad” cholesterol that most of us have heard about. While elevated LDL is a risk factor for heart attack, LDL alone is not a good predictor of an individual’s risk. Because of this problem, more-sensitive cholesterol tests have been developed which look at cholesterol particle size, number, and density. Although cholesterol abnormalities contribute to atherosclerosis there is really more to the story.  For example, LDL particle number is the more important risk indicator.  I'll talk some more about this in a minute.

An issue that feeds the cholesterol controversy is the fact that LDL levels in populations both with and without CAD significantly overlap. In the Framingham Heart Study, for instance, 80 percent of heart attack patients had cholesterol levels similar to those who did not experience a heart attack; and 50 percent of the heart attack victims had normal cholesterol (Castelli, 1996).

Low-density lipoprotein cholesterol (LDL) is a major contributor to CAD, but not the only cause. Risk of getting CAD can be reduced by approximately 20% to 40% if you can get your LDL down to optimal range. This sounds good until your realize that we still have 60% to 80% available for further risk reduction. This is where the benefits of raising HDL come in. Cardiac risk is thought to drop by two to three percent for each 1 mg/dL increase in HDL.

High density lipoprotein (HDL) is the “good” cholesterol. It’s considered good because it facilitates reverse cholesterol transport (RCT). Low HDL cholesterol is an important risk factor for CAD. Anyone with atherosclerosis should be interested in RCT, which means taking cholesterol away from where you don’t want it and metabolizing it. HDL helps remove cholesterol from arteries in the early stages of disease and from established atherosclerotic plaque. This is why having low HDL is a risk factor and also why raising HDL to as high a level as possible helps reverse plaque! The importance of raising HDL cannot be overstated, but is often understated in conventional medicine. Data shows that raising HDL gets similar or even better results than lowering LDL.