For decades, medical practitioners have been advising their patients to keep total and LDL-cholesterol levels within a certain range to protect against cardiovascular disease (CVD). Now, a new expert literature review is challenging the idea that serum cholesterol levels are an independent risk factor for CVD.

Major Findings

The international team of sixteen experts identified considerable flaws in three recent reviews on the subject, and presented substantial evidence showing that total and LDL-cholesterol levels are not indicative of CVD risk. Specifically, the authors noted that:

Total cholesterol levels are generally NOT associated with atherosclerosis severity

Total cholesterol levels are generally NOT predictive of CVD risk

In many studies, LDL-cholesterol levels are NOT associated with atherosclerosis

A large study showed that individuals who experienced a heart attack generally had lower LDL-cholesterol levels

Among adults over 60 years old, those with higher LDL-cholesterol levels generally live longer

Among those with familial hypercholesterolemia (FH), few individuals die prematurely

There is no difference in LDL-cholesterol levels among individuals with FH who have CVD and those who don’t

Also, the experts expressed criticism of the wide-spread use of statin (cholesterol-lowering) drugs. Specifically, they explained that:

Clinical trials of statin drugs did not show a true exposure-response relationship

Statin benefits have been exaggerated, and even questioned

Statin treatment can result in considerable side effects

Implications for People with Diabetes

These findings are especially relevant to people with diabetes who are considered at higher risk to develop CVD. Recent recommendations have even suggested statin therapy for all individuals with diabetes starting at age 40. Meanwhile, in addition to well-established side effects, at least one study has demonstrated that statin therapy appears to increase fasting blood glucose levels, especially in individuals with diabetes.

Conflict of Interest

Of the seventeen authors, one declared a patent on a “homocysteine-lowering protocol,” while seven others authored or edited books that criticize the current cholesterol dogma. No other “relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript” were declared by the review authors. The peer reviewers of the manuscript did not declare any conflict of interest.

Conclusions

“For half a century, a high level of total cholesterol (TC) or low-density-lipoprotein cholesterol (LDL-C) has been considered to be the major cause of atherosclerosis and cardiovascular disease (CVD), and statin treatment has been widely promoted for cardiovascular prevention. However, there is an increasing understanding that the mechanisms are more complicated, and that statin treatment, in particular when used as primary prevention, is of doubtful benefit,” the authors stated in the review abstract.

Strikingly, the expert reviewers noted that, “in our analysis of three major reviews, that claim the cholesterol hypothesis is indisputable and that statin treatment is an effective and safe way to lower the risk of CVD, we have found that their statements are invalid, compromised by misleading statistics, by exclusion of unsuccessful trials, by minimizing the side effects of cholesterol lowering, and by ignoring contradictory observations from independent investigators.”

In summary, an international panel of experts agree that the current dogma suggesting that high LDL-cholesterol levels can cause CVD is highly misleading, while the benefits of cholesterol-lowering statin drugs have been over-stated.

Read more about cardiovascular disease, cholesterol, complications, diabetes management, heart disease, statins, type 1 diabetes, type 2 diabetes.