Today, about half of Americans have unhealthy cholesterol levels. Surprised?

Maybe. Maybe not.

But when you dig a little deeper into how the cholesterol range has evolved—and what it actually means, you might really be surprised…and relieved, too.

Plunging LDL Levels—Millions on Statins

In the 2004, millions of Americans who thought their cholesterol levels were fine got a wake-up call when new guidelines went into effect. At that point, more than 10 million people were already taking cholesterol-lowering drugs (statins). But new recommendations, which modified guidelines set by the feds just two years earlier, meant both that a few million more people needed to be on statins—and that the existing market (10 million strong) needed to increase their doses.

Before this change, the target range for LDL (so-called “bad cholesterol”) was 130. Afterward, federal health officials suggested that LDL should be less than 100–that’s 30 points lower than previously recommended.

There has been much debate over the years about the changes in cholesterol guidelines. (Photo by Mark Scrimshire via Flickr)

Because the change was backed by clinical trials, it was quickly endorsed by the National Heart, Lung and Blood Institute, the American Heart Association, and the American College of Cardiology…in other words, it was endorsed by doctors, some of whom may have had ulterior motives (read on). Other medical professionals felt the evidence was not ironclad, especially since statins were associated with adverse side effects, such as CoQ10 depletion and severe muscle conditions.

2013 brought an even bigger change. By expanding the guidelines to include atherosclerotic cardiovascular disease, around 13 million were now advised to take statins.

For the makers of statin, business was suddenly booming.

But How Much Do LDLs Really Matter?

There’s no question: the makers of statin are beneficiaries of lower LDL levels. Interestingly, six of the 15 panelists that authored the new guidelines reported having recent or current ties to pharmaceutical companies that already sell or were developing cholesterol medications (a disclosure they were required to make by law). While some simply shrug off this potential conflict of interest, others like me find it deeply concerning.

But I wouldn’t agree that patients actually benefit. If someone tells you high cholesterol gave them a heart attack, take it with a grain of salt. While high cholesterol may have been a contributing factor, there are plenty of other conditions that damage the arteries and cause plaque buildup, including:

• Diabetes
• Smoking
• Alcohol abuse
• Low dietary consumption of antioxidants

What’s more, most deadly heart attacks are caused by unstable plaques breaking off and lodging—NOT by chronic buildup that completely closes off the artery. Moreover, the panel never addressed the impact of low HDL (the “good cholesterol”), which is shown to increase cancer risk. Does this have anything to do with the fact that there are no successful medications for low HDL? Hmm.

High cholesterol has become a universally accepted warning sign for heart disease. But many in the medical community question the current standard of care for statin therapy, as these medications may not benefit all patients equally. In fact, The Cochrane Collaboration, a widely respected independent organization, reported that 1,000 people without heart disease would need five years of statin treatment to prevent 18 cardiovascular events. So, on average, 56 people need to be treated over five years to stop one heart attack. Sounds great for that one person—not so much for all the others it didn’t help.

But the fact is, your body needs cholesterol. Without it, you couldn’t manufacture adrenal and sex hormones, and you’d be experiencing low energy levels and a low sex drive, among other things.

Two Cholesterol Tests That May Be Better Predictors of Your Heart Health

Standard cholesterol testing fails to look at important factors like particle dimension and hs-CRP.

If these standards were up to me, I’d recommend a couple of tests that are nowhere in the federal recommendations. For example, particle diameter of cholesterol is one of the most important aspects of heart health. The smaller the particle size, the more dangerous, because smaller particles fit more easily into the cracks of the arteries. But most tests ignore this measurement, and the feds don’t require it.

Standard tests also neglect to look at high-sensitivity C-reactive protein (hs-CRP), which can be more predictive of a heart attack than cholesterol. Your levels of C-reactive protein (CRP), which increase with inflammation and infection, can easily be seen with a simple blood test.

Whether you think you’re in the clear, know you’re at risk, or already have high cholesterol, you have options when it comes to prevention and treatment. Pop some statin, lower your cholesterol, and prevent a heart attack. That’s all it takes, right? Unless you absolutely love taking pills, making dietary changes over a defined time period is unquestionably a safer alternative to medication.

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