Is Cholesterol Good or Bad?
What is cholesterol?
Cholesterol is a waxy, fat-like substance that the body needs. It’s a structural component of every cell membrane. About 80% of cholesterol is made in the liver; only ~20% typically comes from diet.
Types of cholesterol
- Low-Density Lipoprotein
- High-Density Lipoprotein
- VLDL, IDL & Lipoprotein
Why cholesterol gets blamed for heart disease?
- For decades, high total and LDL cholesterol levels have been associated with increased risk of cardiovascular disease (CVD).
- Current research suggests inflammation, insulin resistance, hypertension, oxidative stress, and particle size of LDL may be more critical than cholesterol alone.
The Cholesterol Confusion
Robert DuBroff, a cardiologist at the University of New Mexico in Albuquerque, was surprised to discover that cholesterol levels were nearly identical between those who developed coronary heart disease and those who did not. The only notable differences appeared at the extremes: when total cholesterol was exceptionally high (above 380 milligrams per deciliter) or unusually low (below 150 milligrams per deciliter). “For the vast majority of patients in the middle range, cholesterol levels really did not distinguish who did or did not develop heart disease,” DuBroff explains.
However, few studies suggested that it was “the greatest medical scandal in modern time.”
National Library of Medicine, NIH
For many generations it has been asserted that high cholesterol levels are not only an indicator of but also a causal factor for CVD. More specifically, elevated LDL cholesterol levels are a primary causal factor for heart disease.
Certain studies have found a lack of an association between elevated LDL cholesterol levels and mortality rates. One study even concluded that high cholesterol may help to prevent infections and atherosclerosis, a precursor to CVD that consists of a build up of fatty plaques on the inner walls of an artery.
Some studies have linked statin use to a higher risk of heart attack, and only a small number of studies have shown a modest protective effect. This suggests the role of statins in preventing cardiovascular disease, particularly in low-risk groups, should be reviewed carefully.
Conclusions
The idea that eating foods rich in saturated fat or dietary cholesterol — or simply having “high cholesterol” — automatically causes heart disease needs to be questioned. For decades, people have avoided nutrient-rich foods because of dietary advice based on outdated science.
At the same time, cholesterol-lowering drugs such as statins are widely prescribed, even for people with only modestly elevated cholesterol levels. These drugs are not without risks, and patients deserve clear, balanced information about both their benefits and drawbacks.
Before using statins as a “one-size-fits-all” prevention tool, we should take a hard look at the evidence. And as new research emerges, medical education should be updated to reflect it — even when that means overturning old assumptions.
