A quick look at some new compelling research on statins, fat and cholesterol :
Cholesterol is not just pathogenic, in fact it is what our brains, and artery walls are made of. In a review of 136,905 hospitalizations for CAD almost half had LDL levels less than 100, and more than half had HDL levels less than 40 with less than 10% greater or equal to 60. While the authors of this drug company funded study conclude this may mean that the goals may need to be lower for LDL, this could mean that LDL is less associated with CAD than was previously thought (Sachdeva, et. al., 2009). A recent Cochrane review on statins for primary prevention notes: “evidence of selective reporting of outcomes, failure to report adverse events and inclusion of people with cardiovascular disease” (Taylor, et al., 2010).
Cholesterol is not just pathogenic, in fact it is what our brains, and artery walls are made of. In a review of 136,905 hospitalizations for CAD almost half had LDL levels less than 100, and more than half had HDL levels less than 40 with less than 10% greater or equal to 60. While the authors of this drug company funded study conclude this may mean that the goals may need to be lower for LDL, this could mean that LDL is less associated with CAD than was previously thought (Sachdeva, et. al., 2009). A recent Cochrane review on statins for primary prevention notes: “evidence of selective reporting of outcomes, failure to report adverse events and inclusion of people with cardiovascular disease” (Taylor, et al., 2010).
It is also concluded that raising HDL is an important priority. In a critical reappraisal of the JUPITER trial which claimed benefit for statin drugs in primary prevention Lorgeril, et. al. (2011) present evidence that the results do not in fact support this conclusion and conclude that “troubling questions” were raised about the role of commercial sponsors. Side effects such as: mytosis and myalgia (from muscle pain fatigue and weakness to rhabdomyolysis) as well as mitochondrial effects have been identified which may affect the brain, heart and other organs that have similar mitochondrial mechanisms. Mitochondial defects predispose to adverse reactions on statins, and statins predispose to mitochondrial defects in all users and to a greater degree in vulnerable individuals (Golomb, et al., 2008).
Astrup, et al. (2010) found no clear benefit of replacing saturated fats with carbohydrates. There was a benefit in replacing saturated fats with polyunsaturated fats. The authors concluded that the effects of particular foods on cardiovascular disease can not be predicted only based on their saturated fat content because of the individual saturated fatty acids and other constituents in the food may have effects on cardiovascular disease. A recent meta-analysis of prospective studies with 5-23 year follow up including a total of 347,747subjects that showed no significant evidence to conclude that dietary saturated fat was associated with coronary artery disease or cardiovascular disease (Siri-Tarino, Sun, Hu & Krauss, 2010). However, trans-fatty acids have specific atherogenic, inflammatory, and pro-thrombic effects (Stachoska, 2004; Mozaffarian, et al., 2004).
Many studies have shown higher lipid levels with an increased risk of coronary artery disease with diets high in added sugars and high refined carbohydrate intake (especially greater than 10% of calories) (Astrup, et al., 2010; Jakobsen, et al., 2010; Sieri, et al., 2010; Wesh, et al., 2010).
These are critical details to consider for individual people. Educated, logical decisions about statin use and fat intake should include thought about what is right for the whole body and relate to actual health outcomes and not just biomarkers that are loosely related to disease in some people.
Translation : There is clearly no reason to recommend a statin for primary care prevention. The evidence that shows some benefit with statin use is on white men, but not women, under age 65 who have hyperlipidemia and could be related to statins anti-inflammatory effect rather than their lipid lowering capability (more to come on this aspect). Your HDL cholesterol cleans up the extra cholesterol from your artery walls and is more consistently related to cardiovascular disease.
It's not saturated fat that is the issue, it's destroyed fats and carbohydrates, so anything processed at high heat (including refined oils, or over heating an oil with a low flash point like olive, or old or even slightly heated highly unstable oils like flax, unrefined canola or walnut). There is a short list on my website, and a link to a book on the subject if you would like even more details on fats. Sugar and carbohydrates are stored as energy in your body as fat, while fat is used as energy. So while fat has more calories per gram, it is absorbed more slowly so it helps keep your blood sugar stable and your stress response in check. Refined carbohydrates lower your HDL or good cholesterol and increase your triglycerides and should be limited or avoided in general. Even saturated animal fat has beneficial and necessary nutrients for you body. That being said this means animals that ate their native diets such as grass, NOT GRAINS (even if they are "finished" on grain for the last 3 months of their life) like most of the meat you find at the store and even some called "grass fed" that are "finished." Here are some resources to find healthy sources of animal protein and organic vegetables. Never limit nutrient filled vegetables and fruits and eat for variety, of colors, of fats and of all fresh unprocessed foods !
Translation : There is clearly no reason to recommend a statin for primary care prevention. The evidence that shows some benefit with statin use is on white men, but not women, under age 65 who have hyperlipidemia and could be related to statins anti-inflammatory effect rather than their lipid lowering capability (more to come on this aspect). Your HDL cholesterol cleans up the extra cholesterol from your artery walls and is more consistently related to cardiovascular disease.
It's not saturated fat that is the issue, it's destroyed fats and carbohydrates, so anything processed at high heat (including refined oils, or over heating an oil with a low flash point like olive, or old or even slightly heated highly unstable oils like flax, unrefined canola or walnut). There is a short list on my website, and a link to a book on the subject if you would like even more details on fats. Sugar and carbohydrates are stored as energy in your body as fat, while fat is used as energy. So while fat has more calories per gram, it is absorbed more slowly so it helps keep your blood sugar stable and your stress response in check. Refined carbohydrates lower your HDL or good cholesterol and increase your triglycerides and should be limited or avoided in general. Even saturated animal fat has beneficial and necessary nutrients for you body. That being said this means animals that ate their native diets such as grass, NOT GRAINS (even if they are "finished" on grain for the last 3 months of their life) like most of the meat you find at the store and even some called "grass fed" that are "finished." Here are some resources to find healthy sources of animal protein and organic vegetables. Never limit nutrient filled vegetables and fruits and eat for variety, of colors, of fats and of all fresh unprocessed foods !
References:
Astrup A., Dyerberg J., Elwood P., Hermansen K., Hu F. B., Jakobsen M. U., … Willett, W. (2010). The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: Where does the evidence stand in 2010? The American Journal of Clinical Nutrition. Advance online publication. doi: 10.3945/ajcn.110.004622
Golomb, B. A., Evans, M. A. (2008). Statin adverse effects: A review of the literature and evidence for a mitochondrial mechanism. American Journal of Cardiovascular Drugs, 8(6), 373-418.
Jakobsen, M. U., Dethelfsen, C., Joensen, A. M., Stegger, J., Tjonneland, A., Schmidt, E. B., Overvad, K. (2010). Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: Importance of the glycemic index. American Journal of Clinical Nutrition, 91(6), 1764-1768. doi 10.3945/ajcn.2009.29099
Lorgeril, M., Salen, P., Abramson, J., Dodin, S., Hamazaki, T., Kostucki, W., ... Rabaeus, M. (2011). Cholesterol lowering, cardiovascular diseases, and the rouvastatin-JUPITER controversy: A critical reappraisal. Archives of Internal Medicine, 170(12), 1032-1036.
Mozaffarian, D., Pischon, T., Hankinson, S. E., Rifai, N., Joshipura, K., Willett, W., & Rimm, E. B. (2004). Dietary intake of trans fatty acids and systemic inflammation in women. The American Journal of Clinical Nutrion,79(4), 606-12
Sieri, S. Krogh, V., Berrino, F., Evangelista, A., Agnoli, C., Brighenti, F., … Panico, S. (2010). Dietary glycemic load and index and risk of coronary heart disease in a large Italian cohort: The EPICOR study. Archives of Internal Medicine 170(7), 640-7.
Sachdeva, A., Cannon, C. P. , Deedwania, P. C., Labresh, K.
A., Smith, S. C., Dai, D. ... Fonarow, G. C. (2009). Lipid levels in patients hospitalized with
coronary artery disease: An analysis of 136,905 hospitilizations in Get with
The Guidelines. American Heart Journal, 157(1), 111-117.
Stachowska, E., Dolegowaska, B., Chlubek, D., Wesolowska, T., Ciechanowski, K., Gutowski, P., … Turowski, R. (2004). Dietary trans fatty acids and composition of human atheromatous plaques. European Journal of Nutrition, 43, 313-318. doi: 10.1007/s00394-004-0479-x
Taylor, F., Ward, K., Moore, H. M. T., Burke, M., Davey Smith, G., Casas, J., & Shah, E.
(2011). Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systemic Reviews, 1. (accession No. 00075320-100000000-03785).
Welsh, J. A., Sharma, A., Abramson, J. L., Vaccarino, V., Gilespie, C., Vos, M. B. (2010). Caloric sweetener consumption and dyslipidemia among US adults. Journal of the American Medial Association, 303(15), 1490-1497.
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