Actually, You DO Need To Worry About Cholesterol: A Cardiologist Explains

It's really easy to be confused these days about whether abundant cholesterol is a good thing, or a bad thing in your body. For over 30 years heart specialists have focused on achieving low cholesterol levels in patients with diet, exercise and medication, believing that this was the best way to improve their patients' hearts and health. Several large studies indicated that this was true, and this had long been an important treatment in the field of cardiology.

This type of treatment has recently come under fire. In the last few years, the concept has been questioned by some health care professionals, who often say something about how cholesterol is necessary for brain function, hormone production, and vitamin synthesis. So, they argued, more must mean better.

Since then, some professionals have even advocated basically ignoring blood cholesterol levels. In fact, in a controversial move, the United States changed its guidelines around cholesterol management last November, claiming there wasn't enough evidence to support a "target" cholesterol.

However, a study published this week is bound to reverse the trend. The study, reporting on 38,153 patients with heart disease treated with statin cholesterol lowering medications, brings knew evidence to light showing that significantly lowering LDL-cholesterol has major benefits for cardiovascular patients.

The researchers in this study examined what happened to patients' hearts depending on how much their cholesterol was lowered. What they found was that the patients who lowered their LDL-cholesterol to very low levels (under 50 mg/dL) on medication were 56% less likely to experience a major cardiovascular event (such as death, heart attack, hospitalization, stroke, congestive heart failure).

Those who reduced their cholesterol more modestly (to between 50 and 74 mg/dL and between 75 and 99 mg/dL) also had fewer of these major cardiovascular events — but not to the same degree as those with the lowest cholesterol levels. By contrast this group was about 45 to 50% less likely to experience these traumatic events.

Was this a perfect study? No, it was not. It didn't look at side effects, it wasn't the holy grail design of studies called a "double-blind randomized" study.

The data does, however, reinforce the finding that societies around the world with the lowest incidence of heart disease and the longest life spans have blood cholesterol values lower than 150 mg/dL, more than enough for brain and hormone function but not so much as to clog up their arteries. And it does support the long held belief that monitoring and lowering cholesterol does positively impact patients' heart health.

As a heart specialist, I'd be largely out of work if more people had cholesterol values this low (these low levels can be achieved on plant-based diets or with medication, if necessary). And you know what? That would be just fine with me!

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