Why cholesterol can’t cause heart disease

Introduction

The more you examine the cholesterol-heart hypothesis, the more it doesn’t make sense. This week’s note has been inspired by three things that I read last week. The first was the Appendix to last week’s statin paper in the Lancet (Ref 1). The second was an article “How to beat Heart Disease” in the UK Mail on Sunday newspaper (Ref 2) and the third was Dr Malcolm Kendrick’s latest book “A Statin Nation” (Ref 3).

Before I get on to Malcolm’s book, I have had the pleasure and privilege of spending many hours listening to Malcolm talking about heart disease. The logic with which he approaches the subject is second to none.  I have come across no-one worldwide who has thought about this topic for as long and as openly as Malcolm has. He comes up with a hypothesis himself and then he tries to disprove it. If he can disprove it (and he usually can), he goes back to square one to consider a different hypothesis. The trouble with the cholesterol hypothesis, is that it can so easily be shown not to hold and yet those who believe in it won’t let it go.

One of the most memorable things that Malcolm said about heart disease was this: We know that being male and getting older are risk factors for heart disease. But until we can explain why being male or why getting older increases the risk of heart disease, we don’t understand heart disease. It is not enough to say that older people are more at risk of heart disease – we need to explain why.

The age paradox

The Mail on Sunday (MoS) article thinks it knows why older people die of heart disease. I share this not because the media is an accredited source of medical information, but because millions more people will read a newspaper than an academic paper and it is important to be aware of beliefs – where they come from and how they get perpetuated. The MoS tells us: “As you get older… the effect of your diet and lifestyle accumulates over time leading to a build-up of cholesterol and plaque in the arteries. Four out of five people who die of heart disease are over 65.”

But I had just been looking at the Appendix for last week’s Lancet paper and there was a very interesting table (Webtable 3). The full title for Webtable 3 was: “Mean plasma lipid concentrations at baseline and mean difference in plasma lipid concentrations at 1 year in participants in all studies, by category of age.”