Jane did not want accept that the fat build up in the artery carrying blood to her brain had gotten worse and that she was at risk for a stroke.
“What do you mean my artery is getting clogged up?” she cried. “I have been popping cholesterol-lowering pills for many years and my doctor has been telling me that my bad cholesterol level has been very much under control.”
After more discussion she agreed to further testing which confirmed severe blockage of the artery to the brain due to fat build up. She then underwent surgery and the fat build up was successfully removed.
Cardiovascular surgeons like me, along with other specialists who treat patients with blocked arteries in all parts of the body, deal with people like Jane every single day. Her story happens to be more the rule than the exception. The main reason for this is that having a high bad cholesterol level in the blood is only part of the reason for fat build up in the arteries.
Let me repeat the formula introduced in the last blog post:
I support the taking of cholesterol-lowering pills if you have already suffered a stroke or heart attack. The chances of suffering a second and subsequent heart attack or stroke have been shown to decrease with this approach. Unfortunately, not everybody benefits from these pills. Just like our Jane, fat build up continues even after blood levels of bad cholesterol have been brought well under control. In addition, there is no consensus among the scientists about whether to give these cholesterol-lowering pills to people with a high level of fat in the blood but who have not yet suffered a stroke or heart attack.
Following their Nobel Prize-winning discovery of the defective gene causing familial hypercholesterolaemia, Brown and Goldstein misunderstood the mechanism involved in the pathogenesis of the associated arterial disease. They ascribed this to an effect of the high levels of cholesterol circulating in the blood. In reality, the accelerated arterial damage is likely to be a consequence of more brittle arterial cell walls, as biochemists know cholesterol to be a component of them which modulates their fluidity, conferring flexibility and hence resistance to damage from the ordinary hydrodynamic blood forces. In the absence of efficient receptors for LDL cholesterol, cells will be unable to use this component adequately for the manufacture of normally resilient arterial cell walls, resulting in accelerated arteriosclerosis. Eating cholesterol is harmless, shown by its failure to produce vascular accidents in laboratory animals, but its avoidance causes human malnutrition from lack of fat-soluble vitamins, especially vitamin D.
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Dr Duncan has is just one of many scientists concerned about our preoccupation with lowering blood cholesterol to the exclusion of other remedies. That’s why when it comes to your health you never want to put all your eggs in one basket. Standby as we explore in an upcoming post what makes the arteries attract fat build up and what you can do about it.