If older people with higher cholesterol live longer, then it seems unlikely that high cholesterol causes heart disease.
Adding to the evidence, or lack of it, regarding cholesterol, the average patient admitted to the hospital with coronary artery disease had:
Of these numbers, the total and LDL cholesterol are considered either optimal or nearly so. The HDL and triglycerides are considered abnormal. The number of patients in this study was 136,905, so I think we can say it’s representative.
Further evidence against cholesterol being involved in heart disease comes from Luca Mascitelli and co-authors, who state that “other cholesterol-reducing treatments different from statins have no effect on subsequent coronary mortality.” These other treatments include clofibrate and hormone replacement therapy in women.
The Lyon Diet Heart Study achieved a 70% reduction in mortality in patients with heart disease without lowering cholesterol.
“Furthermore, a dose-response relationship between the degree of cholesterol lowering and clinical outcome has not been demonstrated in statin trials where the dose-response was calculated using individual data.” (Mascitelli et al.)
To summarize so far:
Still think cholesterol causes heart disease?
Acute coronary syndrome is either a heart attack or unstable angina, and among people hospitalized for it, 57% had abnormal glucose metabolism, based on a simple fasting blood glucose (sugar) test. Of those, 66% had not been diagnosed or treated for diabetes.
Approximately 25-30% of patients with acute coronary syndrome have diabetes. Of the remaining patients, most have a spectrum of abnormal glucose metabolism, including previously undiagnosed impaired fasting glucose and diabetes mellitus. (Source.)
When over 1300 patients with impaired glucose tolerance were treated with the diabetes drug acarbose, risk of major cardiovascular events dropped by over 50%.
Acarbose doesn’t just reduce glucose, it reduces insulin and increases insulin sensitivity.
The rate of fatal coronary heart disease among diabetics is from 2 (in men) to 3 (in women) times higher than in non-diabetics.
Check out the following graph, which I discussed here. It shows the results when a team led by Gerald Reaven divided a group of men into tertiles (thirds) by steady state plasma glucose, a measure of insulin resistance. Those with the highest insulin resistance had the most heart disease (CHD). Those with the best insulin sensitivity (lowest insulin resistance) had zero cases of coronary disease — not to mention cancer, stroke, and the rest.
To summarize the relation between blood glucose and heart attacks:
Hyperglycemia — high blood glucose — is a cause of blood vessel disease. When blood glucose gets too high, it causes dysfunction of blood vessel walls (endothelial dysfunction), inflammation, and oxidative stress, eventually leading to plaques.
The old model, that somehow high cholesterol clogs up the arteries like sludge clogs a pipe, makes little sense.