November 18, 2002
Cholesterol And Heart Disease Revisited As The Issue Heats
By Nicholas Regush -
Spring may be far off, but a good cleaning may be in order when
it comes to the well-entrenched claim that cholesterol is the major
villain in heart disease.
Recent attention - and a lot of it - has been focused on the role
chronic inflammation plays in atherosclerosis. Though it has taken
more than a decade to make this area of science respectable, it
is now becoming more obvious that inflammation is involved in all
stages of this disease. Plaque in arteries can become dangerous
should it be weakened by inflammation. A piece of plaque can break
off and form a clot. Once that happens, the blood flow could be
stopped, causing a heart attack.
The implications are considerable. What? No more sole preoccupation
with heart disease being essentially a plumbing problem caused by
cholesterol-laden arteries? Obviously, it is not that simple - and
it never was. The cholesterol hypothesis gang will likely stonewall
as much as it can, even in the face of very strong basic and experimental
science that implicitly challenges the importance of the cholesterol
theory. No one is going to give up medicine's standard theory of
heart disease without a huge fight. Unless, of course, they can
figure out a way to make a quick buck. And doctors are terrific
at saying, Show me the money.
This is not to say that the inflammation crowd moving in will have
all the answers either. Let's not get too carried away and think
that the downfall of one theory means another is true. Not on your
life, it doesn't. What the inflammation model does is get more people
rethinking the whole concept of heart disease that science and the
public have been force-fed for many years.
If you haven't heard already, you will hear a lot shortly about
a cheap test that anyone can take to determine levels of a chemical
called C-reactive protein. It is one of numerous chemicals that
become elevated when inflammation sets in. Evidence is building
that this test may be of some value in helping doctors to assess
risk of atherosclerosis and potential damage to the body.
Can it really be that inflammation will turn out to be more important
than cholesterol in triggering heart attacks? It now looks that
way. Your cholesterol level may be low, but the test for inflammation
may turn out to be a much better indicator of whether you are at
an increased risk of having a heart attack or a stroke.
Naturally, you may be wondering what all this means for the cholesterol-lowering
drugs known as statins that basically top the drug market, to the
tune of almost $20 billion per year. We're talking about drugs such
as Zocor, Pravachol, Lipitor, and Mevacor.
Here is what you will likely hear or read about: Cholesterol is
still very important and therefore statins, which also seem to protect
against inflammation, are now more desirable than ever. You do not
need a crystal ball to predict this next market ploy .
However, look for something else in the pipes: a growing challenge
to the idea that statins really do address cholesterol in an important
way. It may well be that whatever they do to help protect against
heart disease may actually be related to inflammation - not both
inflammation and cholesterol. This one is a battle-royale in the
works, but be patient.
And considering that statins can cause nerve and muscle damage,
deplete the body of valuable CoEnzyme Q10, which helps power cells,
and possibly even contribute to cancer, the shifting tide may eventually
include a reconsideration of their overall value in heart disease.
For a detailed view of inflammation and disease, including neurodegenerative
illnesses, such as Alzheimer's and Parkinson's, one of the hottest
topics in medicine today.