Heart disease

I am not a doctor, and I don’t even play one on TV. I’m just an academic economist who often reads stuff on blogs and in layman’s publications about health and fitness. And it seems that whenever I read something about heart disease, it contradicts the medical profession’s conventional wisdom. Heart disease is the leading cause of death in America, and doctors act as if they know and can do a lot about it, but much of the stuff I read suggests that they have hardly a clue about what really causes heart disease or how to prevent or treat it.

Your doctor carefully tests your cholesterol level, and tells you that you should follow that number as closely as a CEO follows his corporation’s stock price. But as I reported back in June, the latest research shows that cholesterol is not a problem.

Cholesterol does not cause heart disease in the elderly and trying to reduce it with drugs like statins is a waste of time, an international group of experts has claimed.

A review of research involving nearly 70,000 people found there was no link between what has traditionally been considered “bad” cholesterol and the premature deaths of over 60-year-olds from cardiovascular disease.

Published in the BMJ Open journal, the new study found that 92 percent of people with a high cholesterol level lived longer.
[…]
“What we found in our detailed systematic review was that older people with high LDL (low-density lipoprotein) levels, the so-called “bad” cholesterol, lived longer and had less heart disease.”

Vascular and endovascular surgery expert Professor Sherif Sultan from the University of Ireland, who also worked on the study, said…“Lowering cholesterol with medications for primary cardiovascular prevention in those aged over 60 is a total waste of time and resources, whereas altering your lifestyle is the single most important way to achieve a good quality of life.”…

Lead author Dr Uffe Ravnskov, a former associate professor of renal medicine at Lund University in Sweden, said there was “no reason” to lower high-LDL-cholesterol.

And yet, anti-cholesterol drugs remain today the leading class of drugs prescribed in America. Do docs read the same things I read? One of us must be missing something.

Next, consider last month’s piece in The Atlantic about unnecessary medical procedures. One of the procedures highlighted by the article is heart stents.

In 2012, Brown had coauthored a paper that examined every randomized clinical trial that compared stent implantation with more conservative forms of treatment, and he found that stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all. In general, Brown says, “nobody that’s not having a heart attack needs a stent.” (Brown added that stents may improve chest pain in some patients, albeit fleetingly.) Nonetheless, hundreds of thousands of stable patients receive stents annually, and one in 50 will suffer a serious complication or die as a result of the implantation procedure.

In particular, you can die from a post-operative blood clot. For the sake of an unnecessary procedure. Good work, docs!

Unlike statins, blood pressure medications are something I have never really questioned. Cholesterol numbers might be meaningless, but surely blood pressure means something, right?. And blood-pressure medications really do effectively bring down pressure. That would seem to be obviously beneficial, since lowering pressure reduces strain on the heart. Indeed, the conventional wisdom holds that blood pressure medications, known as beta-blockers, have saved untold numbers of lives. And yet, the same Atlantic piece casts doubt on the usefulness of beta-blockers.

[T]he latest review of beta-blockers from the Cochrane Collaboration—an independent, international group of researchers that attempts to synthesize the best available research—reported that they “are not recommended as first line treatment for hypertension as compared to placebo due to their modest effect on stroke and no significant reduction in mortality or coronary heart disease.”

That somewhat awkward language might require a bit of translation. “Not recommended…compared to placebo” means the beta-blockers are worse than doing nothing. They do more harm than good. And the “modest effect on stroke” refers not to a decreased but to an increased risk of stroke. The beta-blockers modestly increase the risk of stroke without reducing the risk of “mortality or coronary heart disease.” What a deal.

Finally, here’s something else I ran across this week. The so-called Seven Countries Study is the most famous study to link heart disease to saturated fat and cholesterol. The 25-year follow up to the original study again found a significant correlation between cholesterol and heart disease. Researchers in the U.K., however, analyzed the same data and found that heart disease correlated even more closely with…wait for it…latitude.

The Pearson correlation coefficient was calculated as 0.72 for baseline cholesterol and CHD deaths at 25 years. The data in the 1993 Menotti article has been examined to repeat the correlations found with CHD death rates and mean serum cholesterol to understand the data and methodology used. The same methodology was then used to explore alternative correlations. The strongest relationship found was for CHD death rates and the latitude of the country or cohort in The Seven Countries Study. The correlation coefficient for CHD deaths and latitude of the cohort was 0.93. The correlation coefficient for CHD deaths and latitude of the country was 0.96. While Keys did find a strong association with median serum cholesterol and CHD deaths, there were stronger associations that were discoverable.
The latitude finding offers an alternative explanation for the observed relationship with cholesterol and CHD. Vitamin D is made when sunshine synthesises cholesterol in skin membranes. In cohorts further [sic] away from the equator, cholesterol is less able to be turned into vitamin D.
Population mean serum cholesterol levels are higher and concomitantly population mean vitamin D levels are lower. Higher CHD could be associated with lower vitamin D, with cholesterol a marker, not a maker, of heart disease.

So according to this theory, the problem is not too much saturated fat, but too little vitamin D from sunshine. The theory casts doubt, therefore, on the alleged benefits of the ‘Mediterranean diet.’ The Mediterranean advantage would be the sunshine, not the food.

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