Cholesterol is a marker for disease and you really want to get at the
underlying cause as you state so the question is not why is the cholesterol
too high. The cholesterol may be low normal or high in disease and in normal
health ie reactive which is why the lipid panel is always performed when you
are not acutely sick.

That would then be an apparent normal physiology and it would thus be
reactive and not pathologic.

Cholesterol is a marker for disease and is involved in tissue repair in both
normal and abnormal physiology. It may not be primary in cause but secondary
in a normal physiological repair process. The normal repair can cause
narrowing of the lumen and in the long run disease. You want to reduce the
availability of the normal repair process by limiting the amount of
cholesterol in circulation.

???????

The classical LDL, TC are not by themselves accurate. Subgrouping of LDL and
lipids are more specific and can explain the so called normal LDL and the
person gets a heart attack. If the LDL is mostly of an abnormal type then
the total LDL is misleading.

Yes it is true that lowering cholesterol with drugs is not safe.
Cholesterol does indeed rise with age and the body does this for good
reason.  It is a well established fact that not only is cholesterol
not a risk factor in elderly people, but those with the highest
cholesterol live longer.

facts about the benefits of high cholesterol by Uffe Ravnskov

http://www.westonaprice.org/moderndiseases/benefits_cholest.html

risks of cholesterol lowering drugs

http://www.thincs.org/pressrelease82004.htm

other good info about cholesterol at The International Network of
Cholesterol Skeptics

http://www.thincs.org

Yes -- Of course it is!

See: http://www.nhlbi.nih.gov/chd/why4.htm
A 1994 study called the Scandinavian Simvastatin Survival Study (also called
4S) found that lowering cholesterol can prevent heart attacks and reduce
death in men and women who already have heart disease and high cholesterol.
For over 5 years, more than 4,400 patients with heart disease and total
cholesterol levels of 213 mg/dL to 310 mg/dL were given either a
cholesterol-lowering drug or a placebo (a dummy pill that looks exactly like
the medication). The drug they were given is known as a statin, and it
reduced total cholesterol levels by 25 percent and LDL-cholesterol levels by
35 percent. The study found that in those receiving statin, deaths from
heart disease were reduced by 42 percent, the chance of having a nonfatal
heart attack was reduced by 37 percent, and the need for bypass surgery or
angioplasty was reduced by 37 percent. A very important finding is that
deaths from causes other than cardiovascular disease were not increased, and
so the 42 percent reduction in heart disease deaths resulted in a 30 percent
drop in overall deaths from all causes.

The 4S researchers say that the following benefits could be expected if
doctors were to treat their heart disease patients for the same 5-year
period and lower cholesterol to the same extent. For every 1,000 patients:

 a.. 40 people would be saved out of the 90 who would otherwise die from
heart disease.
 b.. 70 of the expected 210 nonfatal heart attacks would be avoided.
 c.. Heart procedures such as bypass surgery would be avoided in 60 of the
210 patients who would be expected to need these procedures.
In 1996 the results of the Cholesterol and Recurrent Events (CARE) Study
also showed the benefits of cholesterol lowering in heart disease patients.
This study reported that even in patients with seemingly normal cholesterol
levels (average of 209 mg/dL), cholesterol lowering with a statin drug
lowered the risk of having another heart attack or dying by 24 percent.
These patients were also less likely to need bypass surgery (26 percent
reduction) or angioplasty (22 percent reduction) during the study. Women
benefited even more than men, reducing their risk of having another heart
attack by 45 percent. The CARE researchers estimate that treatment of 1,000
patients similar to those in CARE would result in 153 fewer heart attacks
and deaths from heart disease. If the patients were over 60, there would be
214 fewer, and if they were all women, there would be 248 fewer.

A study published in 1998, the Long-Term Intervention with Pravastatin in
Ischaemic Disease (LIPID) study, examined the effects of cholesterol
lowering in people with CHD (those who had already experienced a heart
attack or had been hospitalized for angina) and who had relatively average
cholesterol levels. The LIPID study used a statin drug to lower cholesterol
levels in the treatment group. All study participants were counseled about
following a cholesterol-lowering diet. The LIPID results showed that a drop
of 18 percent in total cholesterol and 25 percent in LDL-cholesterol
produced a 24 percent decrease in deaths from CHD among the treatment group
compared with the control group. Similarly, cholesterol-lowering in the
treatment group reduced the overall death rate by 22 percent, heart attacks
by 29 percent, the need for bypass surgery or angioplasty by 20 percent, and
stroke by 19 percent. Cholesterol lowering in the LIPID study resulted in
significant reductions in CHD-related deaths and events without increasing
non-CHD deaths.

In the 4S, CARE, and LIPID trials, diabetic patients benefited from
cholesterol lowering as much as nondiabetics. These studies along with many
others support the need to lower cholesterol levels in heart disease
patients. People with diabetes who do not have heart disease have a high
risk for developing it - more than 20% over the next 10 years. People with a
combination of several risk factors may also have more than a 20% risk of
developing heart disease in the next 10 years. If your risk for developing
heart disease is high (you have diabetes but do not have heart disease, or
if you have a combination of risk factors and more than 20% risk in the next
20 years), you can expect benefits from cholesterol-lowering similar to
those in people with heart disease. If you lower your cholesterol, you too
can see benefits like those in 4S, CARE, and LIPID.

Also check out
http://www.washingtonpost.com/wp-dyn/articles/A44702-2004Jul12.html

and check the ATP III Guidelines at
http://www.nhlbi.nih.gov/guidelines/cholesterol/

On the page 25 of the lecture below there is a diagram which shows the
correlations between total cholesterol and coronary heart disease in
The Seven Countries Study. You can see a clear correlation between
high cholesterol and CHD mortality in Northern Europe and in the
United States. However, in countries where flavonoid intake (see page
26) is high and intake of omega-3 fats is also high there is almost no
correlation. I would draw a conclusion that if the diet is not
especially healthy one should try to lower cholesterol. But the best
option is always to correct the diet.

http://www.mgsd.net/uk/medias/Crepaldi_Drouin_lecture.PDF

Jan

Of course we need to lower cholesterol. How else are the
pharmaceutical companies going to earn billions for their share
holders?

TC