Does Lowering Cholesterol Reduce Cardiovascular Disease Risk?

For decades, the public has been told that elevated cholesterol levels are a major cause of heart disease and stroke. However, in recent years, researchers have begun to question this notion.

In an article published in the BMJ (formerly the British Medical Journal) in 2020, an international group of authors discussed the controversy surrounding the use of current recommended cholesterol targets to determine who should be prescribed a statin medication (a primary tool for lowering cholesterol levels). They state the current important targets include: 1) patients who have sustained a cardiovascular event; 2) adult diabetic patients; 3) individuals with low density lipoprotein cholesterol (LDL-C) levels over 190 mg/dl; and 4) individuals with an estimated ten-year risk greater than 7.5%.

However, the authors note that a systematic review of 35 randomized control trials concluded that achieving these cholesterol target levels DOES NOT confer any additional benefit and that using these targets failed to identify many high-risk patients resulting in unnecessary treatment of low-risk individuals and vice versa. Researchers concluded that using LDL-C is questionable as an appropriate target for preventing cardiovascular disease. Further, they describe the significant discordance between well-accepted clinical guidelines and the empirical evidence gleaned from dozens of clinical trials that cholesterol lowering does not reduce cardiovascular disease (CVD) risk or mortality.

Similarly, an April 2018 Journal of the American Medical Association study called SPRINT (Systolic Blood Pressure Intervention Trial) concluded that participants over the age of 65 years old without diagnosed CVD who were taking statins at baseline had no significant differences in primary outcomes when compared to those not taking statins, with or without adjustment for nonrandom statin use and regardless of the ten-year cardiovascular event risk level based on survival/mortality.

So, what DOES increase the risk of heart disease and premature death? An important answer to this question was found in a 2019 study that looked at lifestyle factors and high-risk factors for developing atherosclerosis cardiovascular disease (ASCVD). The study concluded that high-risk lifestyle factors such as poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation, poor gut health, and psychosocial stress ALL affect numerous direct and indirect pathways that lead to ASCVD.

These are all factors linked to elevated inflammation in the body, suggesting that systemic inflammation may be a primary driver of ASCVD and strategies to reduce inflammation may be the key to reducing one’s risk for cardiovascular disease. These strategies include eating a heart-healthy diet, limiting sedentary behaviors, getting regular exercise, maintaining a healthy weight, not smoking, avoiding excessive alcohol intake, getting plenty of quality sleep each night, reducing exposure to pollutants, and managing stress. If aches and pains are affecting your ability to live a healthier lifestyle, schedule an appointment with your doctor of chiropractic.

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