The notion that high cholesterol is bad for you is receiving many challenges. An increasing number of medical professionals and researchers doubt this publicly accepted and heavily promoted argument. The past few weeks saw a couple of especially damaging studies that seriously challenge what most of us think we know about the dangers of high cholesterol.
Is it good to lower cholesterol?
First, a study released a couple of weeks ago linked low LDL cholesterol with increased risk of Parkinson's disease. Remember, LDL is considered the ‘bad’ cholesterol and is what statin drugs reduce. The new study is preliminary and follow up in a much larger study is on the way. Still, the news flies in the face of most people's opinions that high LDL is bad. The study's author predicts that if the data holds true we could see a big rise in the rate of Parkinson's disease from the massive use of statins.
Second, a study published this week argues that lowering cholesterol has very little to do with preventing death. Researchers report that men over 69 had no reduced death rates from statin drugs and that men under 50 benefited only very slightly (about 1 in 50). Women also showed no reduction in death rate with statin drug therapy.
How can this be true? It is definitely a hot topic of debate in the medical field right now. After all, the statin market pulls in $12.2 billion dollars a year. Any evidence against the benefits of statins will meet serious resistance.
What does cholesterol do in the body?
Here's what we do know. Cholesterol is not some evil molecule put in our body to kill us. Our bodies make cholesterol because they need it. It has a vital function and disrupting vital functions with drug therapy always causes side effects. Cholesterol is the starting point for making testosterone and estrogen (required for *** function), cortisol (required for normal response to stress), aldosterone (required for maintaining water balance) and progesterone (important in female cycling and pregnancy). Cholesterol is also a stable part of membranes that surround our cells and it helps them maintain normal function.
So why do we mess with it? Statin drugs were originally developed to help people with familial hypercholesterolemia. This genetic disorder makes your body produce way too much cholesterol, so the use of a drug to slow down cholesterol synthesis can save these folks lives. While ‘normal’ cholesterol levels are a little under 200, people with familial hypercholesterolemia can have levels around 600 or higher! This obviously requires some intervention. However, statin therapy has since become a norm for almost everyone in their golden years and this large scale use is driving serious concerns.
HDL vs. LDL
What's the difference between ‘good’ cholesterol (HDL) and ‘bad’ cholesterol (LDL)? Well, because cholesterol is very greasy it is not soluble in the blood and must move around in protein and lipid balls that can be high density (HDL) or low density (LDL). The LDL form of cholesterol is easily damaged (oxidized) and when this happens, it can start to form plaques in the arteries. The HDL form actually picks up some of the plaques and helps to clear them.
So, thinking that we sufficiently understood the system we created drugs to minimize the production of LDL, which would presumably reduce plaques and reduce the chance of heart attacks. Sounds reasonable, right?
However, as with most of our biology, we really don't understand the system that well. It turns out that messing with cholesterol manufacturing is turning out to cause many other problems that we didn't anticipate. Unfortunately, this is usually the rule and not the exception when it comes to drug therapy.
What's a guy or gal to do?
The question is what should be done about all of the people on statin therapy while this debate rages on? The best thing we can do is to ensure that doctors prescribing statin medications are on top of the issue and have thought seriously about the potential benefits and side effects of the therapy.
Patients must ask more questions to be comfortable that their doctors are proactively involved in continuing medical education and are not simply relying on brochures from the drug companies to dole out advice. Every therapy has an alternative. Only a good patient-doctor relationship can identify the best course of action for each individual. That's why we don't just answer questionnaires on medical kiosks – at least not yet.
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