Cholesterol is a poor predictor of heart attack risk
Most heart attacks occur in people who have “normal” cholesterol. Using cholesterol as the predictor of a future heart attack is not even as good as flipping a coin.
Data from the landmark Framingham Heart Study revealed that the distribution of cholesterol levels among individuals that had a heart attack and those that did not essentially mirrored each other. While cholesterol is involved to some degree in the development of arterial plaque, it alone is not the problem.
Cholesterol is carried in the blood in a variety of different proteins. Each of these particles contain cholesterol, triglycerides and lipoproteins. HDL cholesterol (“good”) has different lipoproteins than LDL cholesterol (“bad”). Within each class, the particles differ in size and density. Simply measuring LDL tells nothing about the particle size or number. The ability of cholesterol to penetrate the arterial lining is dependent on the amount of inflammation present, type of lipoprotein carrying it, the particle size and number rather than on the level of cholesterol in the blood. Two of the most important sub-particles are: Apolipoprotein (apo) B, a component of LDL and apo A-1, a component of HDL.
At the XIV International Symposium on Atherosclerosis in 2006, researchers reiterated findings from the 52 country global INTERHEART study of risk factors for acue myocardial infarction that concluded “the apo B/A-1 ratio was the most important risk factor” and its “predictive power is superior to…any other lipid parameter or ratio”.
Although statin drugs have been shown to lower heart attack risk and lower cholesterol, it is now believed that they are two independent effects. The latest scientific information suggests that statins reduce heart attack risk by reducing silent inflammation; the same risk reduction mechansim attributed to fish oil, stress reduction and healthy lifestyles. One drug, Zetia, is not absorbed and lowers cholesterol in the gut. It has no effect on blood vessels or systemic inflammation and has failed to demonstrate any effect on the progression of atherosclerosis.
At Alternity healthcare, we recommend the VAP test, an advanced lipid profile analysis that directly measures lipoproteins (including apo B and A-1), particle size and number. More importantly, we advise you to have a direct measure of the health of your arteries with a HeartSmart IMTplus carotid artery scan.
In the long run, knowing whether or not you have a problem is what leads to peace of mind. Millions of people are on cholesterol lowering drugs needlessly, while millions more are heart attacks waiting to happen falsely assured by an inadequate blood test result.