Do High Cholesterol Levels Provoke Heart Disease?
Despite the fact that hardly anyone else agrees with me, I believe firmly that the cholesterol hypothesis is wrong. By the time you have finished this chapter, I hope to have convinced you of this fact too. Before starting on the demolition job I must admit that, for many years, I too believed that a raised cholesterol level caused heart disease. On the face of it the evidence seemed overwhelming, and it also seemed to make sense.
The most powerful facts, at least to me, were the following:
Fact One: Atherosclerotic plaques contain a lot of cholesterol, which must have come from the blood. So heart disease had to have something to do with cholesterol-containing lipoproteins.
Fact Two: People with familial hypercholesterolaemia (FH) die very young from heart disease, sometimes as young as five.
Fact Three: Statins lower cholesterol levels and protect against heart disease. Fact Four: ‘Normal’ people (without FH) with higher cholesterol levels are more likely to die from heart disease. These facts seemed concrete and inarguable. Every time I opened a journal, or read a paper, they were confirmed. Again and again. But these facts are really only partially true.
They are rather like the false-fronted buildings used in Westerns. If you look at them from dead ahead, you see what looks like an entire town laid out in front of you. But if you move sideways, just a little bit, you can see that the supposedly solid buildings are just four-inch-thick plywood with nothing behind them at all. And so it is with the second part of the cholesterol hypothesis, raised cholesterol/LDL causes coronary heart desease: Seen from one angle, the facts look solid. But once you decide to quit the ‘opinion leader guided tour’ you get a completely different view.