In answer to a question about cholesterol.
Q - I'm ... confused about getting cholesterol numbers
down. In my reading I've discovered that there is a "cholesterol myth" - Uffe
Ravnskov, Gary Taubes, etc. that says that cholesterol does not cause heart
disease. Why am I trying to get these numbers if cholesterol does not cause
heart disease? I cannot take statins so I'm concerned about this subject.
A - That's right: The issue is not cholesterol, nor was it ever
The issue is the kinds, numbers, and behavior of the
complex particles in the blood that can contribute to atherogenesis, i.e,
atherosclerotic plaque formation. They contain cholesterol, but the cholesterol
component is not the crucial causal factor. These are, of course, lipoproteins.
Small LDL particles, for instance, have a unique conformation that makes
the lysine residues on the resident apo B molecule more prone to glycation.
Glycated small LDL particles are more prone to oxidation. The resultant
glycoxidated small LDL molecule, in turn, is more readily able to cross
intercellular barriers, is more adherent to the components of plaque, are poorly
recognized by the liver receptor for LDL particles and thereby "lives" in the
bloodstream much longer than larger LDL particles, and are avidly taken up by
So viewing this as a "cholesterol" problem is an
incredible oversimplification that tends to focus on the wrongs things, such as
statin drugs alone to "reduce cholesterol."