This is a big one. Diabetics die of heart disease at a rate five times that of non-diabetics. Here’s the frustrating part. Doctors are still concerned with total cholesterol, a fictitious number medicine has been chasing for more than 50 years with very little success. In fact, over half of all people who have suffered a heart attack have LOW cholesterol. Yes, you read that right. Moreover, it’s no secret. Check out this study. Yet medicine continues to chase total cholesterol numbers. Why? There appear to be two reasons that I’ve seen pointing to cholesterol as a potential root cause of heart disease.
- Those with familial hypercholesterolemia are at greater risk for heart attack than those without this genetic condition.
- Statin drugs seem to help lower the risk of heart attack, albeit very little.
In this post, I’m going to argue that total cholesterol is more of a red herring and offer some better indicators of potential heart disease than total cholesterol.
If medicine is using the two reasons above to argue that total cholesterol is a good indicator for heart disease risk, then let’s deconstruct these two reasons and see why total cholesterol may not be a good indicator of heart disease.
From Google definitions: “Familial hypercholesterolemia (abbreviated FH, also spelled familial hypercholesterolaemia) is a genetic disorder characterized by high cholesterol levels, specifically very high levels of low-density lipoprotein (LDL, “bad cholesterol”), in the blood and early cardiovascular disease.” It could be easily argued that those with FH have a other issues besides high cholesterol, like metabolic disorder – a constellation of health conditions ranging from obesity to insulin resistance to high blood pressure, to name just a few. In addition, people with FH have high LDL. Depending on the type of LDL floating around, this is a true risk factor for heart disease and one of the biomarkers that we should definitely pay attention to.
- Statin drugs do lower cholesterol and mildly reduce the risk of a heart attack, but according to the study above, more than half of all heart attacks occur in people with low cholesterol. So, if cholesterol is not what is helping those on statins lower their risk of heart attacks, then what’s the mechanism? Statin drugs appear lower markers of inflammation. But inflammation is easy to mitigate with lifestyle and diet so taking a prescription drug is unnecessary.
Fortunately, we have better risk indicators for heart disease than total cholesterol. Here’s an incomplete list, but should get us started.
- CRP – C reactive protein is a measure of overall inflammation. We should all seek to push this as low as possible since heart disease appears to be rooted in inflammation.
- HbA1C – This is a measure of average blood glucose over the previous three months. Elevated blood glucose is an indicator of diabetes and insulin resistance. Both of these are closely associated with heart disease.
- HDL and triglicerides – These markers make up part of the total cholesterol number, but are much better markers of heart disease. HDL should be high as possible and triglycerides should be as low as possible. Eat tons of vegetables and eliminate processed carbohydrates. Exercise can help with this one as well, but don’t over do it. Over training is associated with chronic high inflammation.
- Fasting insulin – Normal blood glucose levels may not be sufficient to rule out diabetes. Your pancreas may be secreting excessive amounts of insulin in order to get your blood sugar levels down. Testing your morning insulin levels can reveal that you are at risk of diabetes and heart disease.
- Hypothroidism, low testosterone in men, and PCOS in women. Hormonal imbalances can wreak havoc on energy metabolism and insulin resistance. So talk with a doctor about balancing hormones as a means of protecting yourself against heart disease.