Cardiovascular Diseases (CVDs) and the Lipid Hypothesis

About 2.46 million Canadians over the age of 20 live with a diagnosed heart disease. Every hour, 14 Canadians over 20 years of age are diagnosed or die of heart disease and it is the second leading cause of death in Canada. In January 2010, the Canadian Heart and Stroke Foundation designated young adults as the newest at-risk group for heart disease. Rates of high blood pressure, diabetes and obesity are rising exponentially and these risks are becoming more prevalent among all age groups, including adolescents. 

In reviewing some of these statistics we have to ask ourselves WHY is CVD on the rise in people of all ages. Metabolic syndrome, obesity and type II diabetes are considered common risk factors for CVD. Cardiovascular pathologies maintain the lead position in mortality worldwide. Atherosclerosis (cholesterol plaquing in the arteries) can result in myocardial infarction, stroke and other CVDs. Inflammation and lipid metabolism play a role.

Let’s Look at Cholesterol. We have been led to believe for over half a century, that a high level of total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) is considered a major cause of coronary heart disease and other cardiovascular diseases (CVD). Based on this theory, statin treatment has been widely promoted for cardiovascular prevention. If only it were that simple.

Total Cholesterol (TC): Elevated TC does not cause heart disease while lower levels of TC are associated with higher risk of all-cause mortality. 
It cannot be stated strongly enough; elevated TC is not the enemy as we have been led to have believe for many decades. Most people and some doctors still believe that excess cholesterol in can lead to CVD.

However, what is unreported is that cholesterol is an essential component of cell membranes. It acts as an anti-oxidant, is a precursor for the synthesis of vitamin D, E and K as well the production of steroid hormones like the stress hormone cortisol and other adrenal hormones, estrogen, progesterone and testosterone. It is essential for the brain which contains 25% of the body’s total cholesterol and it is critical for brain cell connections that allow you to think learn and form memories. 

Cholesterol, particularly TC and LDL -C have historically been blamed as a cause of CVD, because upon inspection of the arteries of someone having suffered from a heart attack, levels of cholesterol in the arterial plaque were very high. This led to a simple assumption that cholesterol was ‘bad, rather than looking further and wondering why did cholesterol deposit itself in the arteries?  

Elevated LDL-C in and of itself does not pose a risk for CVD however research is showing oxidized LDL-C can increase the risk for CVD.  Oxidized LDL-C (oxLDL) has been modified by oxidation. Oxidation triggers inflammation which leads the development of atherosclerosis and other cardiovascular events. Oxidation of LDL is considered a marker of inflammation. Oxidative stress is viewed as an imbalance between the over production of reactive oxygen species (ROS) and their elimination by protective mechanisms like antioxidants, which can lead to chronic inflammation.
LDL-C is characteristically prone to oxidation but just because a person has an elevated level, does not mean they have a higher risk for CVD. 

How do I know if I have oxLDL and Inflammation? 

In Canada our standard lab tests to not test for oxLDL. There are tests available from private labs however they can be costly. oxLDL is a marker for inflammation and a test that is readily available is C-reactive protein (CRP). CRP is a protein released by the liver in response to inflammation in the body. The higher the level of CRP the more the inflammation.

Another test that is an important indicator for CVD is homocysteine. Elevated homocysteine levels are related to inflammation and early development of heart and blood vessel disease. 

Even slightly elevated levels can significantly increase risk factors and it is associated with the occurrence of blood clots, heart attacks and strokes.
 
Inflammation in the body can be caused by many factors including chronic stress, ultra-processed foods, sugar, gut dysbiosis, and deficiency of antioxidants. The inflammation causes damage to the lining of the blood vessels, and cholesterol is transported to the tissues as part of the inflammatory response to repair the damage. It will only lodge itself in the artery and cause plaque build-up if the artery has become damaged. Cholesterol is not the culprit, and it is becoming a well-known fact that the main cause of coronary heart disease (CHD) and other cardiovascular conditions is chronic inflammation. 

Rather than be concerned about levels of cholesterols, we should be asking ourselves - what is causing the oxidative stress and inflammation and what can I do about it?

The Lipid Hypothesis and Statins

The entire lipid hypothesis has been built around the theory that LDL-C causes CHD and the theory started gaining attention from the scientific community around 1951. It remained controversial for many years due to lack of evidence. And I would say that is still the case, but that is dependent on how the data is presented.

Statistical Deception can create an illusion.  Most studies are based a statistical tool called relative risk reduction (RRR) to amplify the benefits and minimize the risk of a pharmaceutical drug. For example, if a heart attack occurs in 2% of patients in a placebo group and 1% in the treated group, the RRR value would indicate a 50% reduction of risk. 1 is 50% of 2. Well, you say, that makes sense. Does it? 

Based on absolute risk reduction (ARR), the benefit to the treated population is one percentage point. The result if reported as ARR is unlikely to generate enthusiasm from the stakeholders of the trail and the public. Most trials routinely report findings for treatment benefits using the RRR without providing the corresponding ARR benefits and risks.

Statins are the mostly widely prescribed drug in the world. 

A meta-analysis of 21 randomized trials published in the Journal of the American Medical Association (JAMA 2022) examined the efficacy of statins in reducing total mortality and cardiovascular outcomes. The reduction based on ARR was 0.8% for all-cause mortality, 1.3% for myocardial infarction and 0.4% for stroke, with the RRR of 9%, 29% and 14% respectively. 
The results based on ARR suggest benefits of statins are modest at best. This information should have been front and centre in the news and communicated to patients, but instead the study was buried or debunked by the various medical stakeholders.

Another report in the Expert Review of Clinical Pharmacology found that statins may cause coronary artery calcification and impair muscle functions in the heart and blood vessels through the depletion of CoQ-10 and inhibit the synthesis of vitamin K2, a cofactor that protects the arteries from calcification. The report also suggests that statins inhibit selenium proteins causing a deficiency which is a factor in congestive heart failure. 

Health Canada warnings related to statins include rhabdomyolysis (muscle damage), myopathies (muscle pain), memory loss, interstitial lung disease, increased blood sugar and diabetes. What HC does not say is that rhabodomyolsis can lead to permanent kidney damage, coma, and sometimes death. 

Supplement Support

Coenzyme Q10 (CoQ10)

The mitochondria are known as the powerhouse of the cell. They take energy from food and release it as adenosine triphosphate (ATP) which provides energy to all the cells. ATP is necessary for muscle contraction, nerve impulses, and protein synthesis and insufficient CoQ10 inhitibs ATP production. It has been suggested that statins can result in mitochondrial DNA damage impairing muscle function in the heart. 

Vitamin D is the most common deficiency in all age groups in Canada and it has been associated with hypertension, atherosclerosis and heart failure. It plays a crucial role in inflammation and cholesterol plaque vulnerability, and vitamin D3 deficiency associated with statin drugs can accelerate atherosclerosis which also affects brain health. Vitamin D supplementation for all age groups is important not only to prevent CVD but for overall health.

Omega-3’s 

Omega-3 fatty eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), provide anti-inflammatory benefits and are found mainly in fish and fish oil. Omega-3s from fish and fish oil have been proven prevent and to reduce cardiovascular events, like heart attack or stroke, in people who already have CVD. 

Nattokinase

Nattokinase (NK), has been linked to a reduction in CVD mortality. Recent research has demonstrated that NK has potent fibrinolytic activity, antihypertensive, anti-atherosclerotic, and lipid-lowering, antiplatelet, and neuroprotective effects. 

Antioxidant supplements such as vitamin C, CoQ10, grape seed extract, resveratrol, and vitamin E are good examples of antioxidants that can help protect from oxidized stress and inflammation. Inflammation is the main cause of chronic disease including CVDs and neurological disorders.

Some examples of foods that are rich in antioxidants include dark chocolate, berries, colourful fruit and vegetables, green and black teas, and red wine. 

Diet and lifestyle Reminders

I am sure I don’t have to remind anyone about the importance of diet and lifestyle, the foundations of optimal health.

The Mediterranean Diet is an excellent example to follow. Water is vital to our health. It plays a key role in many of our body's functions, including bringing nutrients to cells, getting rid of wastes, protecting joints and organs, and maintaining body temperature. Water should almost always be your go-to beverage. A minimum of 1.5 litres of filtered water daily is a good start.

Exercise on a regular basis can help prevent many chronic diseases. Getting at least 150 minutes a week of moderate physical activity can put you at a lower risk for heart disease. 

For more information, please speak to the knowledgeable staff at the Vitamin Shop.