October 28

LDL cholesterol levels falling

3  comments

A recent study from the Journal of the American Medical Association shows that over the past 40 years Americans have reduced their total cholesterol levels from 222 mg/dl to 203 mg/dl and dropped their LDL cholesterol levels from 138 mg/dl to 123 mg/dl.
The speculation is that this reduction in lipids has come about thanks to an increase in the number of people using statin drugs. Approximately 3.4% of the adult population were taking statin drug in 1988 with an increase to 9.3% of the population by 2002.
I see it a little differently. Although I’m appalled that 9.3% of the adult population is on statin drugs, I believe the decrease in LDL cholesterol has come about due to dietary changes. Over the past 400 years we have seen a significant decrease in the amount of fat in the diet along with a reciprocal increase in carbohydrate consumption. There is no question that if fat in the diet decreases LDL cholesterol falls. In fact, that is the only positive thing that proponents of the low-fat diet can claim. (And it’s only positive if one buys into the lipid hypothesis–otherwise it’s meaningless.) Unfortunately, when LDL cholesterol levels fall as a result of a low-fat diet, the LDL cholesterol particles convert from being the large type A particles to the small, dense type B particles, which are thought (by those believing in the lipid hypothesis) to be much more atherogenic. So the net effect of this fall in LDL levels as a function of a low-fat diet is meaningless because lower levels of more atherogenic particles nets out to not much change in risk.
When people go on low-fat, high-carbohydrate diets they tend to lower their LDL cholesterol levels and increase their levels of triglycerides. Statin drugs have a slight propensity to reduce triglyceride levels, so if the nationwide reduction of LDL cholesterol came as a result of the huge increase in statin drug use, we would see a concomitant fall in triglycerides as well. According to the data presented in this article over the same 40 years triglyceride levels have risen from 114 mg/dl to 122 mg/dl.
I’m quite sure that the drug companies that market statin drugs had a heavy hand in this study because the cholesterol lowering over the past 40 years is already being reported as being due to statin drugs. As reported by the medical news service Medical New Today:

The reason [for the drop in cholesterol levels] is that since the end of the 1980s statins, cholesterol-lowering drugs, have entered the scene. It is definitely not lifestyle that has brought about a drop in cholesterol levels, it is the statins.

According to recent research, statins are the main reason American cholesterol levels have dropped.

In the fine print of the study one finds the following:

Financial Disclosures: Dr Grundy [one of the authors] receives research grants funded by Merck, Abbott, Kos, and GlaxoSmithKline; is a consultant for Pfizer, Abbott, Sanofi Aventis, and AstraZeneca; and receives honoraria from Merck, Abbott, Kos, Bristol-Myers Squibb, and Schering Plough.

And interestingly

No other authors reported financial disclosures.

Not no other authors had financial connections to any drug companies, but simply no other authors reported any financial disclosures. We are left to guess what those financial disclosures might have been had they been reported.
I can’t let this post end without commenting on the piece in Medical News Today. The author, Christian Nordqvist, writes:

Statins lower levels of LDL cholesterol, the bad cholesterol that clogs up the arteries and cause heart attacks.

Notice how it isn’t worded that LDL is the bad cholesterol THOUGHT to cause heart attacks. In Mr. Nordqvist’s mind it is definitive. Irrespective as to whether or not the lipid hypothesis is valid, LDL cholesterol does not clog up arteries, and anyone who writes (or thinks) that it does is ill informed at best, a moron at worst.


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  1. I was looking up a medication tonight on RxList.com and saw a tab for “top 200”. According to the site, the prescription numbers come from NDCHealth Pharmaceutical Audit Suite (PHAST) Prescription Monthly, “Retail Audit reflects retail and mail order pharmacy channels”. Lipitor alone had 69,766,431 Rx in 2004 (number 2 seller overall, number 2 every year since 1999 when it was 3rd) and another 27,234,005 Rx for Zocor (15th on the list for 2004). That’s over 97 million prescriptions in 1 year!!!! For just 2 meds to lower cholesterol.
    Now, according to the CIA Fact book (I have no idea how accurate their numbers are), there are approximately 234,934,412 adults (estimate for 2005) over the age of 15 in this country. That calculates out to about 29% of all adults 15 and older received prescriptions for Lipitor and another 11.5% for Zocor.
    Even if we figure only 1/2 of those given prescriptions are actually taking them, that means there are almost 45million people taking statins….and if you figure 1/4, that’s still over 22 million or over 9% of the population over age 15 are taking statins.
    After reading up on the side effects of statins (or the lowering of cholesterol that they do), those are truly scary numbers!
    My other comment is that JCAHO is currently collecting data on patients admitted for AMI. Among other things, they are collecting LDL levels for these patients. Wouldn’t it be interesting to get their stats in a year or two?
    And my last comment….I find the triglyceride figure of 122 much lower than numbers that I’ve heard from acquaintances, friends and families! Most people I get numbers from (Family members as well as posters on LC, cholesterol, and statin message boards, again unreliable info) give numbers in the 250-350 or even higher range. One man I work with had a level of over 700! (I know the numbers are averages, but still seem pretty low)
    Now a question. Is it possible to ask you a non-medical advice question that you may or may not post, but is unrelated to any one specific blog? Should I just post on your most recent blog?
    I love reading your blogs….and MD’s also. Several msg boards I’m on post your articles, especially your interpretations and reactions to studies and articles! Keep it up! Eventually the rest of the country will realize the craziness that’s being perpetrated!

  2. Thanks for the kind words about the blog. You can attach a non-medical advice question to any old post. As I’ve mentioned before, I can’t give specific medical advice for legal reasons, but non-medical advice is okay. I just don’t know how reliable it will be. Cheers.

  3. A dear friend of mine’s husband just learned he’s got a cholesterol level of 720. His wife is shocked. This dear man was in a rather tough accident 4 years ago and has not been able to resume a full life (near drowning accident). He’s got a pretty severe, persistent form of hypoxia and myclonis (sp?). He’s on several meds to help with constant pain and muscle cramping and needs a lot of rest to keep the pain levels down. He’s a dear man, kind and caring to his wife and family–even with the pain he’s in. He still works as well, but at a sharply reduced rate. He eats at night and over night when he gets up and can’t sleep. He’s on so many meds for the pain that he sometimes doesn’t remember what he’s doing–but he find the ice cream, etc. He’s gained about 40-50 extra pounds and can’t exercise like he did prior to the accident. Doctors have done all they can and are making med changes as necessary. The cholesterol is yet another sign of trouble for the future. My question is, what kind of diet changes can be made (fast) to help this situation? Stop the eating over night—yep, that’s for sure. But, is there any particular diet (Adkins, etc.) that is better than others. I’m just searching for any kind of answer and am trying to help some friends. Thank you for your consideration.
    I’ve had patients with cholesterol in the 700+ range, all of whom have responded well to a low-carb diet. Maybe you should have your friend read Protein Power and discuss it with his physician.
    Cheers–
    MRE

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