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Important Facts About Cholesterol and Heart Disease

Heart Disease Facts

Story at-a-glance -

  • Cholesterol, essential to your health, is both manufactured by your liver and ingested from your food
  • Understanding your cholesterol ratios is more important than looking at a single number
  • Evidence demonstrates use of statins to reduce risk of heart attacks in people over 60 may be a “waste of time”
  • Simple lifestyle choices may reduce your risk for heart disease without the additional health risks associated with statin medications

By Dr. Mercola

Cholesterol is a wax-like fatty substance found in almost every cell of your body. You need cholesterol to make hormones and vitamin D, digest your foods, protect your nerves and for the production of cell membranes.

Although it has been vilified, it is essential to your health. Your liver manufactures most of the cholesterol you require from the nutrients in your food.

Levels of cholesterol are not higher in fatty meats or lower in lean meats. Like your body cells, the cells of all mammals contain cholesterol. Fat cells contain as much cholesterol as other cells in the meat. All meat averages about 25 milligrams of cholesterol per 1 ounce, including beef, pork and poultry.1

Dietary (preformed cholesterol) absorption rates also vary between 20 and 60 percent in individuals.2 This may explain why eating cholesterol affects cholesterol levels differently in different people.

Cholesterol Ratios Are More Important Than Single Numbers

You may be following your cholesterol numbers in terms of the "good" cholesterol (HDL) or the "bad" cholesterol (LDL). But the best way to interpret your cholesterol numbers is to understand your cholesterol ratio.

To say that all low-density lipoprotein (LDL) molecules are bad is an oversimplification of our understanding of cholesterol.

Through the use of new technology to test the size of lipoprotein particles, scientists have identified which sizes are more closely related to heart disease. The smaller sized LDL molecules hold the highest risk for cardiovascular disease (CVD).

Small, dense LDL particles can squeeze between the cells of your arterial lining, the so-called "gap junction" of the endothelium, where they can get stuck and potentially oxidize, turn rancid and cause inflammation and plaque formation. They also have a relationship to other metabolic abnormalities.3

Large epidemiological studies have found people with predominantly small LDL particles are at increased risk for CVD.4,5 Even more interesting is the research demonstrating eating saturated fats increases the size of your small LDL molecules to the larger size and reduces your overall risk of CVD.6,7

The importance of measuring LDL cholesterol through common blood testing has now decreased in value, to the point the American Heart Association (AHA) no longer recommends using LDL cholesterol as a guide in treating the risk for CVD or prescribing statin drugs.8

Instead, a better predictor is the ratio between your high-density lipoproteins (HDL) and total cholesterol. HDL is an important factor in the fight against heart disease. Your ratio between HDL and total cholesterol (or HDL divided by your total cholesterol, multiplied by 100) should ideally be above 24 percent.

Triglycerides are another type of cholesterol formed in your body with excess blood sugar from the metabolism of carbohydrates. They are a significant risk factor in the development of heart disease. Your triglyceride to HDL ratio (triglycerides divided by HDL, multiplied by 100) should ideally be below 2 percent.

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Cholesterol Not a Trigger for Heart Disease

Total Video length: 05:40

In the two videos above, you'll discover some of the history behind why science has clung to the belief that cholesterol is responsible for heart disease, and why they have been wrong.

Recent research9 has again confirmed that high cholesterol is not linked with heart disease in the elderly, prompting the researchers to conclude that reducing cholesterol levels with statin drugs is "a waste of time." Unfortunately, statins are not innocuous drugs, making their use more than just a waste of time.

The research reviewed studies involving nearly 70,000 people to look for a link between LDL cholesterol and premature death in those over 60. Contrary to conventional wisdom, they found 92 percent of people with high cholesterol levels actually lived longer than those who kept their levels at or below "normal."

They concluded the results were "inconsistent with the cholesterol hypothesis (i.e., that cholesterol, particularly LDL-C, is inherently atherogenic)."10 

They believe their analysis of the research provides a reason to question the cholesterol hypothesis and a "rationale for reevaluation of the guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies."11

While termed a "waste of time" by researchers, statins carry with them a list of over 200 side effects and clinical challenges. Some of these include:12,13

Increased risk of diabetes

Acute liver disease

Muscle pain, tenderness or weakness


Acute kidney failure

Chronic liver dysfunction

Endocrine dysfunction

Central nervous system toxicity

Impaired fertility

Increased risk of cancer

Abdominal pain





Skin rash

Nerve damage

Reduced muscle and nervous system coordination

Decreases heart function14

Depletes your body of essential minerals

Memory loss

Before taking medications with such a significant side effect profile, it's important to weigh the risks and benefits of the drug.

In this case, research shows that statins used for primary prevention, or lowering the risk of a cardiovascular event (heart attack or stroke) over 10 years, has a success rate of just 7 in 1,000 events prevented. Put another way, in 99.3 percent of patients there's no appreciable benefit.15,16

Ultimately, statins increase your risk of other dangerous health conditions, while not delivering on the promise to reduce your risk of heart disease or other cardiovascular events. More than a waste of time, they are a danger to your health.

Heart Disease Risk Factors

If saturated fats and high cholesterol levels are not a cause for rising heart disease rates, what is? The numbers of heart attacks and strokes began to rise dramatically in the 1950s, after research was published blaming heart disease on saturated fats.

One correlation, drawn in recent literature, is between the increased amount of carbohydrates eaten when saturated fats are removed from the diet, and the rise in CVD.17 An increase in carbohydrates will raise your triglyceride level, one risk factor for CVD.18

Besides cutting down on net carbs (total carbohydrates minus fiber), another dietary factor that can help decrease your risk is to increase your antioxidant intake. For example, resveratrol, found in grape skins, has been shown to change your gut microbiome and protect against CVD.19

Other risk factors include a lack of exercise and smoking, both of which impact the oxygenation of your heart muscle and subsequent damage leading to heart disease.20,21 Chemicals in tobacco are associated with damage to your blood vessels and heart, and increase the risk of plaque formation.22

Your weight, and more specifically your waist circumference, is another indicator or risk factor for heart disease. Although interrelated, waist circumference is an independent predictor and useful whether you are at your normal body mass index (BMI) or overweight.23 Abdominal fat in adults is associated with type 2 diabetes, high blood pressure and CVD.24

What Is a Silent Heart Attack?

CVD continues to be the leading cause of death in industrialized nations, followed closely by cancer. Chronic lower respiratory diseases are a distant third, at only 25 percent of the total number of deaths from heart disease.25 (Officially, that is. Unofficially, medical errors and prescription drugs are actually the third leading killer in the U.S.)

High blood pressure is a leading cause of heart disease and often called the silent killer, since unless you are tested for the condition there are no clinical symptoms. There are also heart attacks that occur silently, causing damage to your heart muscle and increasing your risk of death with your next heart attack.26

To measure the incidence of silent heart attacks, researchers studied almost 9,500 middle-aged adults, some for more than 13 years. During that time, researchers noted men had more silent attacks, but these attacks killed more women.27

Silent heart attacks are usually discovered during physical examination at a later time since people don't associate any symptoms they may have with a heart attack. Women who have had a silent heart attack are 58 percent more likely to die than women who have not had a heart attack, but the mortality rate for men suffering a silent heart attack is only 23 percent higher than men without a heart attack.28

The study found that nearly half of all heart attacks may be silent and since people don't know they had a heart attack, they don't seek the care needed to prevent another one. Researchers caution that once discovered, those who have had a silent heart attack should be treated as aggressively as those who had a traditional attack with symptoms.

What Can You Do?

There are several modifiable risk factors you can effectively change to make a difference in your risk of suffering heart disease or a heart attack. Reducing your risk factors require changes to your lifestyle, such as the following:

Reduce your waist circumference to within normal limits

Abdominal fat is different from being generally overweight. You can be within normal limits for weight but still carry abdominal fat, increasing your risk of metabolic stress and heart disease. Reducing belly fat requires more than just reducing calories or increasing exercise. In my previous articles titled "4 Ways to Shed Belly Fat" and "Cut Down on Carbs to Reduce Body Fat" I outline several strategies you can use.

Reduce or eliminate smoking

Smoking is a challenging addiction to break. However, it is also a significant risk factor for heart disease. Drugs used to stop smoking have also been linked to an increased risk of suicide. Instead, make a plan, work with a support group, include an exercise program and understand you may stumble once in a while. However, just because you smoke one or two, doesn't mean you have to go back to your old habit.

Reduce your net carbs to 20 to 30 percent of your total caloric intake

Net carbs are equal to the number of grams of carbohydrates you've eaten during the day minus the number of grams of fiber. If you generally eat 1,500 calories per day, you may want to limit your net carbs to between 300 and 450 calories each day.

Eat healthy saturated fats

Substitute healthy saturated fats in your diet for the carbs you are losing. These may increase the size of your LDL cholesterol and protect you against heart disease. They include raw, organic nuts and seeds, avocadoes, pastured organic eggs, grass-fed meat and virgin coconut oil.

Maintain your blood pressure within normal limits

High blood pressure is a silent killer. Maintain yours with nutritional strategies, controlling your fructose and carbohydrate intake, getting outdoor exercise and considering several supplements I discuss in "Foundational Lifestyle Strategies to Maintain Healthy Blood Pressure."

Get at least 30 minutes of exercise each day

A regular exercise routine is one way to improve your emotional, physical and psychological health. It improves your sleep, reduces your risk of heart disease and improves your resistance to infection. Peak Fitness is an exercise program I developed to address the health needs of my body without the damaging effects of hours of cardiovascular work.

Get up and move around during the day

Even if you exercise an hour a day, six days a week, if you sit behind a desk all day you eliminate the benefits to your heart and health. I recommend standing up as much as possible. I've cut my sitting down to about an hour a day, but aiming for a max of three hours of sitting a day is a worthy goal. A stand-up desk is a great investment if you have an office job.

Also make it a point to walk more. The idea is to keep your body moving throughout the day. This can also help increase your productivity and creativity, and may even be helpful if you're struggling with back pain, like I did.

Improve your gut microbiome

Keep your gut microbiome healthy and flourishing to reduce your risk of heart disease and improve your cholesterol ratio. Include fermented vegetables in your daily nutritional plan, eat 50 grams of fiber for every 1,000 calories you ingest and take antibiotics only when absolutely necessary.

Drink green tea

A 2002 Japanese study found that drinking as much as 10 cups of green tea daily, like matcha or sencha tea, can help lower your LDL or bad cholesterol levels while leaving the HDL or good cholesterol unaffected.29

+ Sources and References