Belief in the “Great Cholesterol Myth” has caused us to neglect the real causes of heart disease while obsessively focused on an innocuous molecule that’s essential for life and that we believe has only a minor role in heart disease.
The Great Cholesterol Myth is really a series of related myths that impact everything from our diet to the way we treat heart disease. Here are several of what we believe to be the biggest ones:
Myth: High cholesterol is a good predictor of heart attacks.
Fact: High cholesterol is a terrible predictor of heart attacks.
More than half the people admitted to hospitals with cardiovascular disease have normal cholesterol, and plenty of people with elevated cholesterol have perfectly healthy hearts.
A much better indicator of your overall risk for heart disease is the triglycerides to HDL ratio. If, for example, your triglycerides are 100 and your HDL is 50 your ratio is 2. If, however, your triglycerides are 150 and your HDL is 30, your ratio is 5. A ratio of 2 or under is excellent. A ratio of 4 is considered high, with increased risk.
One Harvard study, published in the journal Circulation, showed that the people with the highest ratio of triglycerides to HDL had 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL. In fact, the ratio of triglycerides to HDL was the strongest predictor of a heart attack, even more accurate than the LDL/HDL ratio.
Myth: High cholesterol is the cause of heart disease.
Fact: Cholesterol is a fairly insignificant player in heart disease.
Inflammation is the primary cause of heart disease. Here’s what happens: Small injuries in the lining of the arteries become inflamed. Small, dense, oxidized (damaged) LDL-B cholesterol particles (among other things) get trapped at the site of the injury; oxidative damage and inflammation increases, ultimately creating a kind of toxic brew that can turn into plaque. Only oxidized, small-particle LDL cholesterol is a problem, and it’s only a problem when there’s inflammation.