"Optimal Cholesterol Level"
No matter where we live,
how old we are, or what we look like,
health researchers have discovered
that 90% of having a first heart attack
can be attributed to nine modifiable risk factors.
The nine factors that are threatening our lives
include smoking, too much bad cholesterol,
high blood pressure, diabetes,
abdominal obesity, stress,
a lack of daily fruit and veggie consumption,
as well as a lack of daily exercise.
But Dr. William Clifford Roberts,
Executive Director of the Baylor
Heart and Vascular Institute
and long-time Editor in Chief
of the American Journal of Cardiology,
is convinced that atherosclerosis has
a single cause, namely the cholesterol,
and that the other so-called atherosclerotic
risk factors are only contributory at most.
In other words we could be stressed,
overweight, smoking, diabetic couch potatoes,
but if our cholesterol is low enough
there may just not be enough cholesterol
in our blood stream to infiltrate
our artery walls and trigger the disease.
Thus the only absolute prerequisite
for a fatal or nonfatal atherosclerotic
event like a heart attack
is an elevated cholesterol level.
It was not appreciated until recently
that the average blood cholesterol level in the United States,
the so-called "normal" level,
was actually abnormal,
accelerating the blockages in our arteries
and putting a large fraction
of the normal population at risk.
It's our number one killer.
That's cited as one of the reasons the cholesterol
controversy lasted for so long:
an unwillingness to accept the notion
that a very large fraction of our population
actually has an unhealthily high cholesterol level.
Normal cholesterol levels may be terminal cholesterol levels.
The optimal cholesterol level, the optimal
"bad cholesterol" LDL level is 50 to 70.
Accumulating data from multiple lines of evidence consistently demonstrate
that that's where a physiologically normal LDL level would be.
That appears to be the threshold above which atherosclerosis and heart attacks develop.
That's what we start out at birth with,
that's what fellow primates have,
that's the level seen in populations free of the heart disease epidemic.
But we can also look at all the big randomized, controlled cholesterol lowering trials.
This is graphing the progression of atherosclerosis versus LDL cholesterol:
more cholesterol, more atherosclerosis.
But if you draw a line down through the points, you can estimate that the LDL level
at which there is zero progression is down around a LDL cholesterol of 70.
You can do the same with the studies preventing heart attacks in the first place.
Zero coronary heart disease events might be reached down around 55,
and those who've already had a heart attack and are trying to prevent a second one
might need to push their LDL levels even lower.
Atherosclerosis is endemic in our population in part because the average person's
LDL level cholesterol is up around 130, approximately twice the normal physiologic level.
The reason the federal government doesn't recommend everyone shoot for at least even just under 100
is that despite the lower risk accompanying more optimal cholesterol levels,
the intensity of clinical intervention required
to achieve such levels for everyone in the population
would financially overload the health care system.
Drug usage would rise enormously.
But they're just assuming drugs are the only way to get our LDL that low.
But those eating really plant-based diets
may hit the optimal cholesterol target without even trying, just naturally nailing under 70.
The reason given by the federal government
for not advocating what the science shows is best
was that it might frustrate the public, who would have difficulty maintaining a lower level.
But maybe the public's greatest frustration would come from not being informed
of the optimal diet for health.