Majority of the cardiologists in the healthcare profession have long championed the “cholesterol hypothesis.” This hypothesis, put simply, states that the high levels of LDL cholesterol are an immediate cause for atherosclerosis. Therefore, improving your high LDL cholesterol levels is a crucial step in reducing the risk of getting atherosclerotic cardiovascular disease.
As a matter of fact, for years, healthcare professionals have highlighted the importance of altering diets for improving elevated cholesterol levels. While on the other hand, pharmaceutical organizations have invested billions of dollars in developing and testing cholesterol medications.
Thus, the cholesterol hypothesis has become entrenched not only among healthcare professionals but also the general population.
It might, therefore, be surprising to hear that many cardiologists are now questioning the validity of this hypothesis. And even though this debate has mainly taken place behind closed doors among professionals, it still doesn’t take away from the relevance and vigor of this argument. Hence, the cholesterol hypothesis isn’t a settled science, despite the public proclamation by some of the prominent healthcare experts.
What Exactly Is the Cholesterol Hypothesis?
The cholesterol hypothesis rests on two important premises. The first premise is that according to the pathologists cholesterol deposits in the body are one of the major constituents of the atherosclerotic plaques. Second, as per the epidemiological studies, individuals with elevated levels of cholesterol have a higher risk of developing cardiovascular disease.
Similarly, in the randomized clinical trials conducted in 1990s, individuals with high levels of cholesterol showed improved results when treated with the statin medications. All of this, therefore, helped prove to the cardiologists and other healthcare professionals that cholesterol hypothesis is indeed valid.
What Are Some New Doubts That Have Arisen About the Cholesterol Hypothesis?
However, with time the validity of the cholesterol hypothesis has been called into question. This is mainly due to the fact that several clinical trials where the individuals were given medications other than the statins, didn’t show any significant improvements.
Therefore, if the cholesterol hypothesis were to be accurate, then those individuals would have shown significant improvements, irrespective of the cholesterol-lowering medication administered to them.
However, this is not what was observed. To clarify it further, in the trials where individuals were given medications other than statins, such as niacin, fibrates, CETP inhibitors and so on, they failed to show any improvement in the cardiovascular outcome.
Hence, it can be stated in cholesterol-lowering clinical trials; cardiovascular outcomes are only improved when the individuals are administered statin medications. All of this, therefore, casts serious doubt on the credibility of the cholesterol hypothesis.
Over here, it’s also crucial to mention that these doubts were made public in 2013 in the form of a publication. This publication listed new guidelines for controlling the cholesterol levels by focusing on which individuals should be treated with statin medications. As a matter of fact, for many individuals, these new guidelines cautioned against using non-statin medications to lower elevated levels of cholesterol. Thus, these new guidelines discarded the classical form of the cholesterol hypothesis to create a major controversy within the healthcare community.
What Is the Reasoning Behind Completely Discarding the Cholesterol Hypothesis?
The reasoning behind completely giving up on the cholesterol hypothesis is that, if elevated levels of LDL cholesterol are the immediate cause of atherosclerosis, then lowering these levels of LDL cholesterol by any type of medication should by default improve the cardiovascular outcomes. However, after the results from various randomized cholesterol-lowering clinical trials, this result wasn’t observed. Therefore, the cholesterol hypothesis must be false.
But where does that even leave the statins, you might ask? To answer the question; statins don’t improve the cardiovascular risk by lowering the levels of elevated cholesterol per se. Instead, they do so through the help of other non-cholesterol effects.
What Is the Reasoning Behind Revising the Cholesterol Hypothesis?
On the other hand, some of the healthcare experts strongly express their contention against discarding the importance of cholesterol levels. This is because they hold the idea that no matter how you choose to cut your cholesterol levels when it comes to cardiovascular disease, cholesterol will always be important.
To clarify this statement further; the atherosclerotic plaques contain cholesterol. And, when you try to reduce the elevated levels of LDL cholesterol in your body, the atherosclerotic process is reduced to some extent. Therefore, it isn’t wise to completely disregard the importance of cholesterol levels and the cholesterol hypothesis.
What Should the Cholesterol Hypothesis Be Revised to?
It’s already clear that cholesterol is crucial to the development of atherosclerotic plaques in your body. It’s also clear that while high levels of LDL cholesterol correlate with the chances of developing atherosclerosis, there’s more to this than just your blood levels.
This is because not every individual with elevated LDL cholesterol levels develops atherosclerosis, nor do all individuals with atherosclerosis have high levels of LDL cholesterol. Thus, it shows us that it isn’t only the blood cholesterol levels that play a part, but rather it also depends upon the type of the lipoprotein particles and their behavior.
Therefore, a new, revised cholesterol hypothesis should factor in things like the LDL, HDL, and lipoproteins and their behavior.
Conclusion
To conclude, it can be seen that the classic cholesterol hypothesis is quite limited and simplistic in its view of cholesterol levels being the sole determiner of the cardiovascular disease. All of this has left the healthcare experts in an unfamiliar place where the hypothesis once used to be.
Thus, keeping all of this in mind, it’s crucial that you don’t forget that significant lifestyle changes and drugs prescribed to you for treating coronary disease have major benefits. However, you should always be careful never to halt your treatment without speaking to your healthcare professional first.