Cholesterol’s Shady Past

Up until 2013, Medical Doctors were trained to keep an eye on risk of heart disease by monitoring cholesterol levels. The instruction was straightforward: keep total cholesterol below a certain number to be safe. At first, it was below 6.2mmol/L, then 5.2mmol/L. Doctors would use lifestyle or pharmaceutical interventions and thought it was all the same to the body. As long as the lab numbers were good, it was thought the person was protected from heart disease.

Then in 2013 a big change happened, in light of new evidence on the real impact of this medical approach. Statistical analysis showed clearly that total cholesterol didn’t matter as much as we thought. Target levels were not as protective as doctors were trained to think and, in fact, lowering cholesterol with pharmaceuticals can often be harmful in other ways that offset the benefit of using them.

A 2013 New York Times blog article by Harlan M. Krumholz, MD stated, “Studies over the past several years have shown that improving your lab profile with drugs is not equivalent to lowering your heart risks. Drugs have thousands of effects on the body, and a drug’s effect on an individual lab test cannot necessarily predict its overall effect on you”.

New guidelines were needed for doctors, and new goalposts had to be created for patients. What would keep patients safe, and how could doctors help them achieve it? A strong reconsideration of statins was called into order from many in the conventional and complimentary medical fields. It wasn’t a heart disease wonder cure- and their use still remains in question among many medical professionals.

New Guidelines

First, drug treatment is still recommended for people at high risk – people with lots of factors that would make it more likely for them to suffer heart disease. These factors include one or more of the following: high blood pressure, cholesterol and triglyerides, high blood sugar, a smoker, first-degree family members with heart disease, little to no exercise, high stress lifestyle or job, or having had a previous heart attack. Having many of these factors is so risky for further cardiovascular issues that it is considered medically worth the tradeoff to temporarily use statins to lower risk. Of course, this decision is up to the patient, once they are fully informed of the risks involved on both sides of the equation.

But for other people with only some of these factors, new guidelines were created by breaking down heart disease risk into a range of measurements of health. New parameters were discovered to more closely represent a person’s risk of heart disease, such as high LDL cholesterol, low HDL cholesterol, high non-HDL cholesterol, and other overall health measurements such as blood glucose levels, triglycerides, Hemoglobin A1c, hip:waist ratio, and others.

But if we learned anything from the former days of targeting lower cholesterol, we should not focus solely on lowering specific parameters. The best way to guide treatment is to calculate your overall cardiovascular risk using the Framingham Risk Calculator , and make decisions from there, using individualized medicine for the patient. If a person has significant risk, doctors now target their highest risk factors to reduce their chance of heart disease and stroke. Naturopathic doctors excel in individualized medicine and take into consideration the risks and benefits of all treatments, offering treatments with low adverse effects.