LDL: The Life-Delivering Lipoprotein

The Bullet Points:

• LDL cholesterol has an inverse association with overall mortality, those with the highest LDLs live the longest.
• LDL is not “lousy cholesterol” as it decreases infectious disease and cancer mortality.
• If you have CAD a treatment might be initiated to correct inflammation and the small dense LDLs that can exacerbate pre-existing atherosclerosis.
• If your LDL goes up, look for and treat the myriad reasons why your body senses a threat in the environment.
• Never, ever go on a treatment for high cholesterol without first evaluating your risk by getting a CAC first.

Many of you have asked me to publish an article solely focusing on why I don’t treat elevations in cholesterol, specifically, the artist formerly known as “lousy” cholesterol, as a disease. All the other doctors do, why are they wrong? Because I practice science-based medicine and am not a priest of the Western medical belief system. And science is ever evolving and never speaks in terms of “truth”.

Cholesterol profiles are unique to the individual and are much more complicated than LDL (often called “lousy”), HDL (“Happy” cholesterol), and triglycerides. However, in reality, a high triglyceride (>100) and low HDL (<50) predict mortality far better than LDL. As no good drugs exist that improve these numbers, while also improving outcomes, your doctors tend to ignore these two important numbers. They focus instead on a number they can lower but must first convince you they should treat that number. Unfortunately, what they tell you is misinformation.

I am placing my references, non-traditionally, in the middle of the article, where you can access through PubMed: an article with ID # of PMID 27292972. “Found in BMJ Open “Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review”, this 2016 article does a comprehensive review of prospective trials evaluating LDL and all-cause mortality in the elderly (those over 60 years old, and yes, I found this irritating at age 61!).

The importance of this meta-analysis comes from the known correlation, mildly, between high cholesterol and cardiovascular mortality in younger individuals, that fades after the age of 60. This is also why we screen everyone for coronary artery disease (CAD) with a coronary artery calcium score (CAC). We begin screening all men at age 45, and all women at age 55. We also screen any individual 15 years earlier, given that a first-degree relative developed evidence of CAD. This means that if your father had a myocardial infarction (MI - “heart attack”) at age 55, we would begin screening you at age 40, male or female or nonbinary.

If you develop premature CAD as evidenced by an abnormal CAC, you begin treatment for that CAD and not for high cholesterol. The aggressiveness of treatment and evaluation depends on you and your doctor's experience with this test. I have been ordering, interpreting, and basing ever-evolving treatment recommendations based on this test since about 1990!

On to this comprehensive article, and to the way we should apply it. If you have been asked to go on any form of cholesterol-lowering medicine, screen first for CAD with a CAC. Never, and I do mean never, treat a high cholesterol found on a lab test as a disease, but instead as a potential imbalance.

In a meta-analysis of 30 cohorts of 68,094 people over 60 years-old, the 4-year mortality among those with the highest LDL was up to 36% lower than among those with the lowest LDL! Was this possibly due to recommendations to replace saturated fat with vegetable oils, leading to a 30 mg/dl drop in total cholesterol causing a known 22% increased mortality? (PMID 38942429)

Or the more likely reason comes from data showing that LDL acts as an “acute phase reactant” (classically a term saved for proteins seen in acute inflammatory responses) that binds to and inactivates a broad range of microorganisms and their toxic byproducts. (QJM 2003;96:927-34.)

From this article:

“Also, in a 15 year follow-up study of more than 120,000 individuals, Iribarren et al. found a strong inverse association between t-C (total cholesterol) and the risk of being admitted to hospital due to an infectious disease. Statistically significant, inverse associations were found for urinary tract infections, all genitourinary infections and miscellaneous viral infections for women, and for urinary tract infections, musculo-skeletal infections and skin and subcutaneous infections in men. Inverse, but non-significant associations were found for most other infectious diseases. In a similar study of more than 100 000 individuals followed for 15 years, a strong, inverse association was found between t-C and the risk of being admitted to hospital because of pneumonia or influenza, but not for chronic, obstructive pulmonary disease or asthma.”

LDL cholesterol also binds to mutagenic (cancer-causing) viruses as well as other hydrocarbon toxins so common in our environment protecting us from their mutagenicity. This is why there is an inverse association between LDL and cancer mortality!

Finally, and briefly, “LDL-C does not cause cardiovascular disease…” from Expert Reviews in Pharmacology (PMID 30198808), notes the problem with publication bias and how misinformation gets propagated by a few groups invested in spreading this misinformation.

One great review from the famous Framingham Heart Study published in 1987 reported for every 1 mg/dl drop in total cholesterol per year, there was an 11% increase in coronary and total mortality. Three years later the American Heart Association fraudulently referred to this study and told people that for every 1% reduction in total cholesterol leads to a 2 % reduction in CAD risk.

We have been lied to, repeatedly. Those lies come from those who benefit from you being diseased. This reflects the cancer stage of capitalism that we currently find ourselves in.

Educate yourself that saturated fats and cholesterol never caused CAD. That lie was sold to you, like the food pyramid, like margarine, and so many grievous errors that doctors still, to this day, have been duped into telling their patients.

Higher than normal cholesterol from your baseline can be related to so many imbalances, from endocrine including thyroid, to inflammatory, and most commonly metabolic syndrome from low fat diets, lack of exercise and stress. Evaluate and treat the causes of higher-than-normal cholesterol from your baseline, don’t just drug or supplement them. Signs and symptoms are our teachers.

Listen to your teachers, don’t just “shut them up”.

Your Journey to Health & Healing,
Gary E. Foresman, MD