Analysis: There is a wealth of research showing that the root cause of heart disease is chronic inflammation and not cholesterol
The leading cause of death worldwide today is what we call cardiovascular diseases (CVD). This includes a range of conditions affecting the heart and blood vessels, such as coronary artery disease, heart failure and arrhythmias. It is the most lethal of diseases: 17.9 million people die worldwide every year due to cardiovascular diseases, with 10,000 deaths in Ireland per year (one person per hour).
For decades, scientists we had made a wrong explanation for this, namely the lipid hypothesis. According to this, cardiovascular diseases are related to high levels of cholesterol so cholesterol was demonised. This demonisation has formed the way of thinking of hundreds of thousands of people such as health professionals and entire organisations such as HSE in Ireland and NHS in UK and gave birth to statins.
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From RTÉ Radio 1's Brendan O'Connor, the lowdown on cholesterol from Prof Robert Byrne, Director of Cardiology at the Mater Private Group
It's quite amazing how easily GPs around the world suggest statins as the recommended medication for cardiovascular diseases. They still think that lowering cholesterol levels decrease the cardiovascular risk for patients, but this is not the case as recent research has shown. Indeed, if statins could reduce cardiovascular risk and heart disease, then why we do we have about 17.9 million people worldwide dying every year?
Role of cholesterol
Cholesterol has many important functions in our bodies and it is essential for human life. It’s an important component of cell membranes, contributes to the structural make-up of the cell membrane and plays a key role in cell’s fluidity. Cholesterol is also a precursor molecule for many key molecules in our body (e.g. vitamin D, steroid hormones and sex hormones). It is also a constituent of bile salts that are used in digestion to facilitate the absorption of all fat-soluble vitamins (i.e. A, D, E and K).
Statins are so widely prescribed you probably know a person taking them. They completely stop the biosynthesis of cholesterol in the body, which accounts for 70% of total cholesterol. The other 30% comes from foods. By taking statins, our body is starved for cholesterol causing several strong side effects (e.g. muscle pain, digestive and liver problems and, in some cases, the onset of Diabetes Mellitus type 2).
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From RTÉ Radio 1's Today with Claire Byrne, does cholesterol cause heart disease?
Types of cholesterol and cardiovascular risk
Today, the approach that "cholesterol is bad for you" is neither scientifically correct nor effective. When talking about cholesterol, we need to consider the fact that there are two types in our body: The "good" cholesterol that is called High Density Lipoprotein (HDL) and the "bad" cholesterol that is called Low Density Lipoprotein (LDL). The role of HDL is dual: It removes excess cholesterol from the tissues and arteries and returns it to the liver where cholesterol is removed from the body and it protects the artery walls against the formation of thrombus (i.e. a blockage).
The low/high ratio is related to cardiovascular risk and not the absolute levels of cholesterol. When this ratio is below 2, the risk is lower so the prescription of statins is not a 'golden standard' and 'one fits all' medication. Of course, there are cases that statins are absolutely necessary, such as genetic hypercholesterolaemia, but they are not the answer for the general population.
Today, the lipid hypothesis is dead and all that frenzy for light dairy products was actually wrong. In 2018, we published a paper entitled "Dairy fats and cardiovascular disease: Do we really need to be concerned?" Then, we wrote that "recent research and meta-analyses have demonstrated the benefits of full-fat dairy consumption, based on higher bioavailability of high-value nutrients and anti-inflammatory properties. In general, evidence suggests that milk has a neutral effect on cardiovascular outcomes but fermented dairy products, such as yoghurt, kefir and cheese may have a positive or neutral effect".
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From RTÉ Archives, George Devlin reports for RTÉ News in 1990 on comments by new president of the Irish Heart Foundation Dr Michael Walsh that heart disease is the country's biggest killer
Inflammation and heart disease
Today, there is a wealth of research that supports the view that the root cause of heart disease is not cholesterol but chronic (sustained) inflammation. Inflammation can be either acute (e.g. when we injure ourselves and the body reacts by aggregating the platelets to stop bleeding) or chronic.
The latter is caused by smoking, bad diet, polluted air and water, chemical compounds in our food and sedentary lifestyle (and even chemotherapy!). It is the cause of platelet and innate immune cell activation, unleashing the complement system and coagulation cascade. Therefore, we need to tackle chronic inflammation if we want to reduce cardiovascular risk.
What’s the solution?
Each of us is unique and different to the person who is next to us in the bus. As the concept of personalised nutrition is gaining ground, we thus need to become the personal trainers of our body and mind using a holistic approach.
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From RTÉ Radio 1, Blackrock Clinic preventive cardiologist Dr. Paddy Barrett on dealing with a family history of heart disease
Blue zones offer some useful suggestions in this regard. These are five regions where people become centenarians without diseases and where there are nine common lifestyle characteristics (the "power of 9").
We could draw some useful examples from "power of 9" and try to modify accordingly our daily routines but also our goals in life and prioritise the well-being of us and our beloved ones. Before starting to take statins, have a look into the power of 9.
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The views expressed here are those of the author and do not represent or reflect the views of RTÉ. If you have been affected by issues raised in this article, support information is available online
