Is the link between cholesterol and heart disease bogus?

Q. High cholesterol runs in my family. At 17, my cholesterol was high, and my doctor told me to cut back on saturated fat and foods that contain cholesterol (like eggs and shrimp). Sure enough, my cholesterol came down.  But I keep seeing articles arguing that the conventional wisdom on diet, cholesterol, and heart disease is all wrong. What’s the real consensus now?

A. That’s just it: There is no consensus.  The American Heart Association continues to tell folks that they should avoid saturated fat and cholesterol-containing foods in order to keep their cholesterol low and reduce the risk of heart disease. But, as you’ve discovered, there is a whole lot of research that seems to contradict this. In fact, virtually every link in the argument appears suspect.

First of all, the impact of dietary cholesterol on blood cholesterol is far less than expected.  More to the point, cholesterol levels are a very poor predictor of who will develop or die of heart disease.  Although reducing saturated fat intake can somewhat reliably reduce blood cholesterol, it doesn’t seem to reduce the risk of heart disease. In fact, lowering high cholesterol by any means doesn’t reduce deaths from heart disease.

Most of this data, however, is based on large population pools and doesn’t predict an individual’s experience.  For example, people with familial hypercholesteremia (genetic factors that affect how their bodies process cholesterol) have a dramatically increased risk of heart disease.  For these folks (unlike the population at large), reducing blood cholesterol can greatly reduce the risk of mortality–and reducing dietary cholesterol has a greater impact on blood cholesterol.

The fact that high cholesterol “runs in your family” does’t necessarily mean that you have familial hypercholestermia.  But the fact that you had high cholesterol at a very young age could be another tip-off. Your doctor can screen you for the genetic mutation so that she can tailor her advice to your particular situation.

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