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75% of Those Who Have Heart Attacks Have Normal Cholesterol: A Special Report

According to the UCLA Newsroom a new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were NOT at high risk for a cardiovascular event, based on current national cholesterol guidelines. In fact, you might be surprised to know that in the Framingham Heart Study, which is the longest-running and perhaps most significant study on heart disease done to date, it was demonstrated that intake of cholesterol in the diet had absolutely no correlation with heart disease. Another consistent thorn in the side of supporters of the “lipid hypothesis” is that women suffer 300% less heart disease than men, in spite of having higher average cholesterol levels. At the recent Conference on Low Blood Cholesterol, which reviewed 11 major studies including 125,000 women, it was determined that there was absolutely no relationship between total cholesterol levels and mortality from cardiovascular or any other causes.

This is astonishing:

In 2004, the U.S. government's National Cholesterol Education Program panel advised those at risk for heart disease to attempt to reduce their LDL cholesterol to specific, very low, levels. Before 2004, a 130-milligram LDL cholesterol level was considered healthy. The updated guidelines, however, recommended levels of less than 100, or even less than 70 for patients at very high risk. Keep in mind that these extremely low targets often require multiple cholesterol-lowering drugs to achieve.

Fortunately, in 2006 a review in the Annals of Internal Medicine found that there is insufficient evidence to support the target numbers outlined by the panel. The authors of the review were unable to find research providing evidence that achieving a specific LDL target level was important in and of itself, and found that the studies attempting to do so suffered from major flaws.

Several of the scientists who helped develop the guidelines even admitted that the scientific evidence supporting the less-than-70 recommendation was not very strong.

So how did these excessively low cholesterol guidelines come about?

Eight of the nine doctors on the panel that developed the new cholesterol guidelines had been making money from the drug companies that manufacture statin cholesterol-lowering drugs.

What roles does cholesterol serve in our bodies? How important is it?

  • necessary component of every cell membrane in the body

  • low levels linked to possible low testosterone (with all its symptoms and that will be the focus of another report)

  • low levels of all the sex hormones like testosterone, estrogens, progesterone (all of these are made from cholesterol)

  • low levels of vitamin D (which is made from cholesterol and is a major contributing factor to diabetes, heart disease, increased risk of several kinds of cancers,

  • low levels increase the probability of dementia and memory-related disorders

  • low levels increase the risks for depression and anxiety

  • low levels diminish ability to combat stress (most stress related hormones are made from cholesterol)

  • low levels contribute significantly to muscle soreness, fatigue, heart failure (which is why so many cholesterol lowering medications caution that taking those drugs could cause these side-effects)

  • cholesterol is the precursor (mother) of many of the hormones which determine mineral balance in our entire bodies and blood sugar balance

  • cholesterol is the "mother" of many of the hormones and substances that prevent against harmful inflammation and healing

  • low levels contribute to low libido, dizziness, hearing difficulties, edema, and infertility,

I could continue, but I think you get the idea.

So, then which simple, inexpensive, internationally recognized tests really give us as physicians the kind of information we need to assess cardiovascular disease risk:

1. C-reactive protein (CRP) is produced by the liver in response to inflammation in the body. If monitored early enough, elevated CRP can be an early warning of a heart attack several years in advance.

2. Fasting Glucose (FG) measures fasting blood sugar. Lowest all-cause mortality is associated with fasting glucose in the range of 80-89 mg/dl.

3. Fibrinogen is a protein that in excess promotes blood clots. Elevated fibrinogen = thicker blood. Thicker blood flows less easily through partially blocked arteries. Consistent elevated fibrinogen conveys a 250 percent increased risk of heart disease compared to people with fibrinogen levels below 235.

4. Homocysteine is normally rapidly cleared from the bloodstream. Elevated homocysteine is a result of B-vitamin deficiencies, particularly folic acid, B-6 and B-12. Elevated homocysteine is associated with increased risk of heart attack, stroke, and all cause mortality.

5. Lipoprotein(a) has been called the “heart attack cholesterol.” Lipoprotein(a) is a sticky protein that attaches to LDL and accumulates rapidly at the site of arterial lesions or ruptured plaque.

6. HDL is made in the liver and acts as a cholesterol mop, scavenging loose cholesterol and transporting it back to the liver for recycling. HDL is associated with protection from heart disease. You want as much HDL as possible.

7. Triglycerides (TG) should be under 100 mg/dl. Triglycerides are blood fats made in the liver from excess energy - especially carbohydrates. Risk is linear—the higher the number, the greater the risk, especially for women.

8. TG:HDL ratio is the most reliable predictor of heart disease. Calculate your ratio by dividing TG by HDL. As an example, if TG = 80 and HDL = 80, your ratio is 1:1 representing low risk of heart disease. If your TG = 200 and your HDL = 50, your ratio is 4:1 representing serious risk of heart disease.

9. VLDL – Increasingly, Very Low Density Lipoprotein is measured/calculated. VLDL is sent out from the liver to deliver those liver made fats (Triglycerides) - as opposed to a Chylomicron that delivers dietary fat from the gut.

10. LDL particle size: Small dense Pattern B/Large fluffy Pattern A: LDL - low density lipoprotein - is a family of particles. A lot of people with elevated LDL do not develop coronary artery disease, while individuals with low or modest levels often develop serious disease. This can be explained by the LDL particle number and size. Routine cholesterol testing only reveals the amount of LDL; not the quality of LDL. We now know that there are different subclasses of LDL (and HDL). Under an electron microscope, some LDL particles appear large and fluffy; others small and dense. The big, fluffy particles are benign, while the small dense particles are strongly associated with increased risk of heart disease. In excess, small dense LDL is toxic to the artery lining (the endothelium), and much more likely to enter the vessel wall - become oxidized - and trigger atherosclerosis. It's becoming consensus medical opinion that only oxidized LDL can enter the macrophages in the lining of the arteries and contribute to plaque buildup.

Dr. Valcarcel designed it to provide the most cutting-edge, evidenced-based tests and assessments to help you prevent serious heart disease, discover increased risk for cardiovascular events before they happen, or work with non-drug options to help you. Both doctors believe that there are times when you, as a patient, warrant treatment by them and a conventional, allopathic specialist. So, Dr. Valcarcel will co-manage your treatment if outside referrals are warranted. Your health will always come first.

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