Are Statin Drugs Good For Me?
Cholesterol is BAD. Or is it?
Let us take a look at cholesterol and see if we can separate the fact from the fiction.
What we do know is that there are a lot of doctors and health care professionals who are advising us to reduce our cholesterol levels. The advertising companies seem to be onboard with a host of products that claim to do just that – reduce our cholesterol.
And of course, let us not forget the pharmaceutical companies that have supplied many millions of dollars worth of statin drugs that very effectively reduce cholesterol.
Cholesterol is a lipid, waxy steroid found in the cell membranes of all animals and is transported in blood plasma. It is an essential component of cell membranes, where it is required to establish proper membrane permeability and fluidity. In addition, cholesterol is an important precursor molecule for the biosynthesis of bile acids, steroid hormones, and several fat-soluble vitamins. Cholesterol is the principal sterol that is synthesized by all animals, including humans.
About 25% of total daily cholesterol production occurs in the liver. Other sites of cholesterol synthesis include the intestines, adrenal glands, and reproductive organs.
The view that a change in diet can lower blood cholesterol levels, and thereby reduce the likelihood of the development of coronary artery disease and the need for heart bypass surgery is now being increasingly challenged.
An alternative view is that any reductions to dietary cholesterol intake are automatically counteracted by organs such as the liver, which will increase or decrease production of cholesterol to keep blood cholesterol levels constant. It is also being widely argued that in fact a reduction in cholesterol does not significantly reduce the incidence of coronary heart disease.
Total cholesterol is defined as the sum of the lipids HDL often referred to as “Good Cholesterol”, plus LDL often referred to as “Bad Cholesterol” plus VLDL often referred to as “Very Bad Cholesterol”.
The reality may of course be somewhat different as much of this is still theoretical. Biosynthesis of cholesterol is directly regulated by the cholesterol levels present in the blood plasma, though the homeostatic mechanisms involved are as yet only partly understood, as indeed are the full functions of HDL, LDL and VDL.
This means that in declaring certain parts of the overall make up of cholesterol as “Good” or “Bad” certain - and as yet unproven - assumptions must be made.
So this is how the theory goes:
Abnormally high cholesterol levels with higher concentrations of LDL and lower concentrations of HDL are associated with coronary heart disease because these appear to promote atheroma development in the arteries. This leads to arterial diameter reduction which causes high blood pressure which in a “vicious circle” process may cause myocardial infarction (heart attack), stroke, and peripheral vascular disease.
Since it is believed that higher levels of LDL, especially higher LDL particle concentrations and smaller LDL particle size, contribute to this process more than the cholesterol content of the LDL particles, LDL particles are often termed “bad cholesterol” because they have been linked to atheroma formation. Alternately, high levels of HDL, which can remove cholesterol from cells and reduce atheroma, are often referred to as “good cholesterol”. These balances are largely genetically determined but can be altered by body build, medications, food choices, and some other factors.
Once atheroma formation in the walls of arteries has begun, a condition known as atherosclerosis, which is currently thought to be the principal cause of coronary heart disease and other forms of cardiovascular diseases begin to develop.
Increased concentrations of HDL correlate with lower rates of atheroma progressions and even regression and thus the possibilty of reversing atherosclerosis appears to exist.
Total cholesterol counts can be a very misleading indicator of risk. The total cholesterol can be within normal limits and yet be made up primarily of small LDL and small HDL particles, under which conditions atheroma growth rates would be high. In contrast, if the LDL particle number was low (mostly large particles) and a large percentage of the HDL particles were large, then atheroma growth rates could be low or even negative.
There are some cardiac specialists who are beginning to doubt the wisdom of reducing cholesterol and they have instead been studying the effects of inflammation as the possible cause of increase in Cardiac Events.
Even if cholesterol reduction is a desirable goal, many are now questioning the benefits versus the risks of taking cholesterol lowering drugs, which already are known to be associated with many adverse and serious side effects.
In conclusion, it would seem to be the best policy to listen carefully to what all sides of the medical argument have to say and to try to make your own informed judgement.
Some of the few proven facts are that calorific restriction whilst maintaining excellent nutritional value does reduce heart disease and does in general lead to longer life, but the mechanisms involved in this are not fully understood yet.
Regular exercise and a diet rich in natural fresh fruit, vegetables and nuts has shown to improve the quality of life for the average person that is not yet displaying signs of coronary illness and may go some way towards preventing it.
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