When faced with high LDL cholesterol levels, many people become alarmed and are quickly recommended statins to lower these levels. But is this always warranted? Is high LDL cholesterol a reliable indicator of heart disease risk, especially for those on low-carb diets without other significant risk factors like high blood pressure or insulin resistance?
Do statins really reduce the risk of heart disease and early death in individuals with high cholesterol who haven’t had a cardiovascular event such as a heart attack or stroke?
In this piece, I shall respond to these queries. Let's clear up some misconceptions and disinformation regarding the importance of high LDL cholesterol on a low-carb diet. All set? Now let's get started.
The Misunderstanding of LDL Cholesterol
Over the past 20 years, low-carb diets have become more and more well-liked due to their ability to help people lose weight and treat metabolic problems like insulin resistance, high blood sugar, and high blood pressure.
Nonetheless, low-carb diets are frequently criticized in conventional medicine for raising LDL cholesterol levels. LDL cholesterol has long been thought to be a major cardiovascular disease risk factor.
Although several studies have linked elevated LDL to an increased risk of heart disease, new research conducted over the past 20 years has revealed that this relationship is inconsistent and more complex than previously believed. Let's investigate this more.
Familial Hypercholesterolemia (FH)
Studies on people with familial hypercholesterolemia (FH), a condition causing very high LDL cholesterol levels, do not support the idea that high LDL alone is a significant risk factor for heart disease. If LDL cholesterol were inherently problematic, we would expect cardiovascular mortality to increase in people with FH as they age.
However, this is not the case. In fact, cardiovascular mortality decreases in people with FH as they get older. Older individuals with FH have similar levels of cardiovascular mortality to younger people without FH, and they have a lower risk of death from all causes than those without FH.
Coronary Artery Calcium Scoring
Recent studies have challenged the notion that LDL cholesterol is a strong independent risk factor for heart disease. Other risk factors, like coronary artery calcium scoring, have proven to be far more reliable predictors of fatal and non-fatal coronary events.
Calcium scoring is a more accurate predictor of cardiovascular disease risk over periods of more than a decade, and among people with FH, only half have high calcium scores despite elevated LDL levels.
Benefits of Low-Carb Diets
Large reviews of randomized controlled trials have shown that low-carb diets improve virtually all cardiovascular risk factors other than LDL cholesterol. These include body weight, body mass index, abdominal circumference, blood pressure, triglycerides, glucose, insulin, C-reactive protein, and HDL cholesterol.
Studies by Virta Health, a company using low-carb diet treatment programs to reverse type 2 diabetes, have shown that low-carb diets significantly reduce ten-year cardiovascular risk scores.
The Role of Statins
The mainstream view that high LDL cholesterol is always a significant risk factor for heart disease is not supported by evidence. But what about statins for people with high LDL cholesterol who do not have many other risk factors? Unfortunately, there’s limited research on this topic, but two studies provide some insight.
Statins and Cardiovascular Events
The first study, based on the well-known 4S study, looked at the impact of statins in reducing subsequent cardiovascular events in people with a history of heart disease.
It found that statins only reduced cardiovascular events in people with other risk markers like high triglycerides and low HDL. Statins had no effect on those with high LDL but low triglycerides and high HDL, common in people following low-carb diets.
The Prosper Study
The Prosper study examined elderly men aged 70 to 82 with pre-existing vascular disease or who were at increased cardiovascular disease risk due to hypertension, diabetes, or smoking. This trial found that statins only benefited men with low HDL, regardless of their LDL levels.
The study noted that variation in baseline LDL concentrations did not relate to the risk of coronary events or treatment efficacy.
Statins and Overall Mortality
Most studies suggest that statins do not reduce the risk of death from all causes in people with high LDL but few other risk markers. For example, a review showed that statins did not reduce total mortality in people with a ten-year cardiovascular disease risk of less than 20%.
Using these criteria, only 2% of women in their 50s and 16% in their 60s qualified for statin therapy, while 9% of men in their 50s and 48% in their 60s did.
Conclusion
To summarize:
- LDL cholesterol is not a strong risk factor for heart disease in the absence of other risk factors like a high calcium score, insulin resistance, or hypertension.
- Low-carb diets reduce the risk of cardiovascular disease, even when LDL cholesterol is high.
- Statin drugs have not been shown to reduce the risk of death in people without pre-existing heart disease who have a low-risk profile or in those with high LDL but low triglycerides and high HDL.
To obtain more information, check out the free e-books, "The Lowdown on Low Carb" and "The Diet-Heart Myth". If you liked this article, subscribe to our blog for more updates and share it with anyone who could benefit from it. Thanks for reading!