This concluding part of the heart health series describes the real causes of heart disease.
What really causes Heart Disease?
We know that there is often no specific cause for a given disease. We also understand that a variety of factors might influence the natural history of a disease.
I believe there are a number of factors that contribute to the development of heart disease. Of all the factors listed below, LDL cholesterol is missing, deliberately, because I see no evidence whatsoever to implicate it.
- Metabolic Syndrome, including central obesity
- High blood pressure
- High blood sugar and diabetes
- Advanced age
- Psychological stress
- Bacterial infection
- Blood clotting abnormalities
The list above is only a summation of observations. In Part 1, I proposed a series of questions that should be asked, to help us understand the aetiology (origin) of cardiovascular disease. This seems to me to be a logical attempt to explain how the various factors might interact. Dr. Malcolm Kendrick, a GP, and author of The Great Cholesterol Con authors the best and most extensive blog I have ever seen, dedicated to forensically investigating all these factors. It is written beautifully and is well worth a read.
There is no singular cause of heart disease. Our best bet in understanding the world’s biggest killer is to stop looking for the causes and start looking at the mechanisms of this disease.
Heart disease is now understood to be an inflammatory process, resulting from an injury to the wall of the blood vessel. The injury is the first insult. It, therefore, stands to reason, that the appropriate questions to ask, are:
- What is damaging the wall of the artery?
- What is contributing to the progression of the disease?
- What is interfering with the normal clotting mechanisms?
There is no singular cause of heart disease. The image below illustrates some of the main contributing factors. It is evident that the obsession with cholesterol is wholly inadequate – and almost certainly misguided. Most of these contributing factors are modifiable and should, therefore, remain front and center in any strategy to combat this disease.
We have had decades of deception – data manipulation, the use of relative risk to amplify the beneficial effects of statins, trial design manipulation, and under-reporting of adverse effects. Statins have been prescribed with reckless abandon. But they are not, and have never been, wonder drugs.
- High cholesterol levels are not inherently dangerous. We know that elderly people with higher cholesterol levels live longer. We also know that dietary cholesterol does not have any significant impact on blood cholesterol levels.
- The small benefit of statins is outweighed by their numerous side effects. The increased risk of developing diabetes and heart failure is unacceptable, and not trivial. There is no logic in trying to prevent CVD, while simultaneously causing iatrogenic (drug-induced) heart failure.
- When it comes to heart health, LDL is only one piece of the puzzle. There are many more avoidable and unavoidable contributing factors, that have a much bigger role to play than LDL.
- The vast majority of statin trials are funded and published by the drug manufacturers. This favours the benefits of the drug and underestimates the risks. Their interests may not necessarily align with public health goals.
- The raw data on the side effects of statins have never been released to the public. This is an unacceptable practice, as sharing data with other researchers is vital for scientific transparency.
- Manufacturing a new drug is very expensive. Big Pharma knows this and therefore join forces with vested interests to widen the net on the prescription of the available drugs, to include as many people as possible. For instance, the safe cholesterol number used to be 6.5mmol/L some years back. This dropped to 5.5, and it is now less than 5. This has become accepted practice, with absolutely no evidence of benefit.
- Promoting the use of drugs for healthy people (primary prevention), an enormous potential market, is a powerful business strategy for pharmaceutical corporations in need of showing sustained profit growth to their shareholders. This is what the JUPITER trial sought to achieve.