My cardiologist says.....

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 cholesterol.

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 inflammatory cells.

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."

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