Heart Attacks: What Big Medicine Doesn’t Want You to Know

The Truth About Cholesterol, Fat, and Heart Disease

You’re being lied to. Here’s what’s true and untrue about taking care of your heart health.

Jake recently underwent heart surgery – a quintuple bypass. Amazingly, he didn’t have any of the traditional risk factors. His blood pressure and cholesterol were normal. He didn’t smoke, eat a fatty diet, or have high iron levels. Despite all this, his doctor discovered blockages that could dislodge at any moment and cause a heart attack, hence the bypass.

What’s going on here? How did a healthy guy get so blocked up? The book, “Open Heart,” by Jay Neugeboren, gives us some shocking insights.

The Cholesterol Boogieman

Neugeboren, a healthy man with no overt risk factors associated with heart disease, underwent heart surgery after being repeatedly misdiagnosed. After his near-death experience, he began researching heart disease and unearthed mountains of disturbing information.

Consider first the issue of cholesterol: More than a third of individuals who have heart attacks have normal cholesterol. And if you look at all the studies, you’ll find no evidence that lowering cholesterol prolongs life. Disturbingly, there’s a mysterious increase in deaths from other causes when you reduce cholesterol. And once you drop cholesterol below 180 mg/dl, the death rate also increases.

Yet every two years, experts from around the world meet and decide that the normal and accepted cholesterol level is invariably lower than it was at the last meeting – without having any solid evidence to back it up.

By the early 1970s, each biochemical step of the chain from dietary fat to cholesterol to heart disease had been mapped out, but the legitimacy of the claim has never been proven.

The closest they’ve come is through a study funded by the US Surgeon’s Office. They determined that if Americans cut the amount of saturated fat they ingested, they could delay 42,000 deaths each year. That means that a woman who avoided saturated fat her entire life – who otherwise might have died on her 65th birthday – might live an additional two weeks. So, the role saturated fat plays in heart disease is controversial. Other factors may be involved.

There Are Lies... Then There Are Statistics

So where did the cholesterol myth originate? The drug companies that manufacture cholesterol drugs.

A study involving the cholesterol-lowering drug cholestryamine (Questran) and 1900 patients found that out of those taking the drug, only 30 had a fatal heart attack. And the number of those not taking the drug that had fatal heart attacks? Thirty-eight.

Statistically, that means the cholestryamine, over seven years, reduced the chances of having a fatal heart attack by less than half a percent. However, the drug company said that cholestryamine reduced the chances of dying from a heart attack by 25%. Sure, eight fewer deaths out of a total of 38 patients is indeed 25%. As they say, there are lies, and then there are statistics.

But even if cholesterol does lead to severe blockages, these blockages cause, at most, three out of every ten heart attacks. While doctors used to believe that heart attacks were caused by a build-up of plaque that would eventually rupture and cause blockages, that isn’t necessarily the case anymore.

So, What Does Cause Heart Attacks?

If you combine all known risk factors such as the wrong kinds of fat in the diet, cholesterol, smoking, high blood pressure, markers for inflammation, and diabetes, they explain only half the risk of developing atherosclerosis. The answer most often given to explain this conundrum is that it’s likely genetic, which, according to Dr. Rich Helfant, a cardiologist, is another way of saying, “We don’t know why these things happen.”

A recent path of research points to another possible cause: hormone balance. One meta-study compiled the results of 100 testosterone studies and found that low testosterone was associated with higher rates of cardiovascular disease and higher rates of mortality in general. The severity of the disease correlated with the degree of testosterone deficiency.

Estrogen levels, too, are important in men. When researchers monitored the estrogen levels of men with chronic heart failure, men with estradiol in the normal range (between 21.80 pg/ml and 30.11 pg/ml) had the fewest deaths during a three-year period.

Men with the highest levels (above 37.99) had 133% more deaths during the same period. However, the men with the lowest estrogen levels (below 12.90) fared the worst as they experienced 317% more deaths. Clearly, estrogen levels play a big part in the health of your ticker, in addition to the health of a whole lot of body parts, body systems, and body functions.

Five Different Doctors, Five Different Diagnoses

There’s also the problem of diagnosis itself. “Put a patient with even the slightest set of maladies in front of five doctors, and you might get five different diagnoses, five different prognoses, and five different recommendations for treatment,” explains Dr. Helfant.

One study involving 453 recent medical school graduates found that more than 20% of the time, the grads couldn’t identify common heart problems with a stethoscope, which is still a valuable tool for diagnosing heart problems.

While we seem to hold more technical diagnostic tools in high regard, the truth is much different. One study found that 75% of information leading to a correct diagnosis comes from detailed patient history; 10% comes from physical exam; 5% comes from routine tests; 5% comes from invasive tests; and 5% of the time no answers are found.

Also, regardless of whether a doctor recommends bypass surgery, angioplasty, drug therapy, or beating-heart surgery, the results are usually the same. Even if a patient receives optimal treatment, there’s less than a 50% chance that the patient will live longer than he or she would have without the treatment.

Lab Tests Suck, Too

Even common lab tests are woefully inaccurate. Consider the common blood test for cholesterol. Dr. Helfant says that if you send a blood sample to two different labs, there’s a strong possibility that you’ll get two different results.

As an experiment, Helfant had the same lab repeat his cholesterol test on the same blood sample. The first time, the machine indicated that his total cholesterol was 152. The same sample tested at 176 a few minutes later, a discrepancy of 17%. With the high number, he could’ve been prescribed a cholesterol drug with questionable side effects.

Neugeboren sums it up by writing, “When a test is performed more often, the result is both fewer missed cases and more false positive results.”

Greed and Shady Doctors?

According to Dr. Stephen Oesterle, over 50% of angioplasties performed each year in the US are unnecessary. That translates to over a hundred thousand needless and risky procedures yearly. The other side of the coin? Some patients who need treatment are sometimes misdiagnosed and end up dying.

Could there be something more at work regarding some of these unnecessary procedures, something more sinister than ineptitude?

According to one report, nine out of ten medical experts who make recommendations concerning the treatment of diseases have financial ties to the pharmaceutical industry. These ties are rarely disclosed. Similarly, many cardiologists and surgeons own stock in companies that make cardiac stents, surgical instruments, catheters, and drugs. All too often they’re also involved in the clinical trials that examine the efficacy of these products.

So Where Does That Leave Us?

Doctors can’t agree on what causes heart disease. Sure, some statistical probabilities point to lowering blood pressure and cholesterol, but they don’t mean squat if you’re one of the 50% of men or 63% of women who die from heart attacks while not exhibiting any strong risk factors.

Similarly, the “correct” treatment is often based on widely varying opinions, outdated science, and even corruption and greed. The only thing that doctors and scientists seem to agree on is that heart disease is a disease of inflammation.

What’s common to just about everyone who dies of a heart attack is a large collection of white blood cells known as macrophages. These macrophages collect around fatty deposits, and they secrete enzymes that digest protein. The insides of blood vessels are made of proteins and in trying to eliminate the fatty deposits, the blood vessels are eaten away, made thinner, and made more susceptible to rupture.

Surprisingly, researchers also found these macrophages in presumably healthy arteries, indicating that the inflammation was systemic and not localized.

This may be why aspirin, which reduces inflammation, seems to be valuable in thwarting heart disease. It might also explain why some statins seem to work – not because they lower cholesterol – but because they have an anti-inflammatory effect.

How to Protect Your Heart

Put all that disturbing info together and you’ll realize that working out and keeping your blood pressure in check may not be enough to prevent a heart attack.

Avoiding trans fatty acids and limiting saturated fat is still sound advice for everyone, but more than that, and given that heart disease seems to be an inflammatory disease, it might be wise to take the following every day:

  • 80 mg. of aspirin (if you’re not at risk for hemorrhagic stroke)
  • 4200 mg of fish oil, mostly from DHA. Flameout (Buy at Amazon) contains mostly DHA.
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  • 400 mg. of magnesium (crucial to proper heart function, and something most Americans are deficient in). ElitePro Vital Minerals (Buy at Amazon) contains 400 mg of chelated magnesium to ensure absorption.
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  • Between 90 and 200 mg. of CoQ10 (Buy at Amazon) (which is essential if you’re on cholesterol drugs).
  • 400 mg. of curcumin to help fight inflammation. Use only the micellar form, which is 95 times more bioavailable than standard curcumin with piperine. Biotest’s Micellar Curcumin (Buy at Amazon) contains these solid lipid curcumin particles that greatly enhance absorption and utilization.
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And of course, eat as many fruits and vegetables as you can work in, along with nuts or olive oil (for their monosaturated, heart-healthy fats).

While it seems that an anti-inflammatory diet and lifestyle are our best insurance against heart disease, we need to also make sure our testosterone levels and estrogen levels are within healthful parameters. Low levels of the former and high levels of the latter appear to play a big part in heart disease.

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Dr. Paul Mason: Arteriosclerosis is cause by damaged LDL cholesterol. Damaged LDL has been glycated and oxidized. These are even smaller and denser than regular LDL and that is what gets stuck on damaged arteries. Constant high blood sugar is what causes the damaged LDL. Another contributing factor is plant cholesterol from especially seed oils which visually look like LDL crystals in plaque under a microscope, but are chemically different.

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“So where did the cholesterol myth originate? The drug companies that manufacture cholesterol drugs.”
I hope T-nation isn’t shut down for spreading misinformation.
Badmouthing or questioning Big Pharma or its products is now labeled dangerous misinformation by the same folks who told us the Covid virus could live on some surfaces for 6 days.

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Before I have even finished reading this, I recall when 200 was considered to be a healthy level of cholesterol. I took cholesterol meds for awhile, but I began getting the side affects.

The pharmas lower the numbers and sell more meds. Bastards.

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This is not a strong article. It is true a significant percentage of people who have heart attacks have few risk factors. Traditionally, these risk factors include diabetes, smoking, high blood pressure, family history before age 60, obesity, high LDL, low HDL among other things. This is well known by doctors, who are completely fine with you knowing this.

Doctors generally agree on medical diagnoses, prognoses and treatment, with some fairly trivial variations. A study of medical school graduates, who have not yet started their residency, means little. It is true history and physical exam are very important, and tests are often less useful than many suppose. But it matters a great deal what you are specifically talking about. Each test has different sensitivities and specificities, levels of validation, and can be used at appropriately - or not. Even well-written books (like Attia’s Outlive) recommend some dubious tests. A lot of popular health books recommend many useless tests and boundless questionable interventions.

As a Canadian, our doctors are not incentivized to do useless tests. Most people are prescribed reasonable medicines if appropriate. Which is not to say marginal procedures or drug company influence is not a thing in Canada. But it is an order of magnitude less than in the States.

It is pretty unusual to see patients who still take cholestyramine, and many studies have happened since the 1970s. The HOPE-3 trial in 2016 (NEJM) showed 10mg of rosuvastatin in 12,705 patients without heart disease reduced their LDL 26.5% vs. Placebo and had reduced vascular events including stroke and MI (from 4.8% to 3.7%). This is a significant effect, though it is smaller than many expect. Still, it is not true there is no evidence of a mortality and morbidity benefits to lowering cholesterol.

Confusingly, the article than says:
“But even if cholesterol does lead to severe blockages, these blockages cause, at most, three out of every ten heart attacks.” as if that is not very significant.

I think regular exercise, including at least two strength training sessions and 90 minutes of cardio per week, is amazing for your heart and likely better than almost any medication. You will live longer, and more of those years will be healthy and functional.

Given emerging evidence on inflammation, doctors have no problem with patients taking curcumin, fish oil, people who exercise taking magnesium, or people at low risk of falls or bleeding taking baby aspirin at appropriate doses. They might debate the risks and benefits, but likely reducing inflammation is beneficial. Eating a wide mixture of vegetables and phytochemicals, including those found in nuts and olive oil, or fruits like strawberries (fisetin), blueberries (cyanosides) or pomegranates (punicalagins are anti-atherogenic), and getting enough fibre would likely help. TC Luoma has written some solid articles about this topic.

Don’t much agree with the hormone relevance. Premenopausal women were thought to have fewer heart attacks since estrogen was protective (even if thrombogenic, especially in smokers). This is a weaker risk factor than the traditional ones, which are far from perfect since many people who have heart attacks have few or no risk factors.

Getting trans fats out of food has made an enormous difference to health. People die less often from cardiac events over the last few decades. Saturated fat might also be a bit of a boogeyman; the benefits of reducing it seem modest in recent studies.

I don’t have a problem with the conclusions: exercise often and reduce inflammation. Your list would benefit many. But especially the exercise.

But the enthusiasm of Big Pharma, and overselling of the benefits of some medicines, does not mean there is not a lot of evidence about treatments. Saying otherwise is wrong. And the 10-year risk of a heart attack is still meaningful and people at higher risk need more aggressive treatment. Still, even niacin remains useful, and cholesterol is hardly all-important. Regular exercise is still better than taking pills; but not everyone exercises enough, is at equal risk, or has the same comorbidities.

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