Cholesterol: facts and myths

THE OBJECTIVE OF THIS ARTICLE IS TO ANALYZE SOME OF THE IDEAS LINKED TO CHOLESTEROL AND STRENGTHEN OR REBATE THEM, BASED ON THE EXISTING EVIDENCE.

 

Article under the responsibility of Prof. Pedro Monteiro, Physician at the Cardiology Service A of the Centro Hospitalar e Universitário de Coimbra

 

High cholesterol, which the medical community calls hypercholesterolemia, is a very common situation in the Portuguese population, with some studies indicating that 1 in 3 Portuguese adults has high cholesterol.

In recent years, we have witnessed important advances in this disease, with particular relevance to its risk stratification, with the definition of progressively lower limits of normality, and to its pharmacological treatment, aimed at reducing cholesterol levels, especially the so-called “bad” cholesterol or LDL cholesterol, with the ultimate objective of preventing its main complication, coronary disease (and within this, above all, acute myocardial infarction).

Despite all these advances and the much invested in improving knowledge related to hypercholesterolemia and its diagnosis and treatment, numerous and important challenges still remain.

The purpose of this article is to analyze some of the ideas linked to cholesterol, particularly among the Portuguese, and to reinforce or refute them, depending on the existing evidence.

WHAT IS THAT GOOD AND BAD CHOLESTEROL?

Cholesterol is all the same, but its benign or malignant character depends on the type of lipoproteins to which it is linked. If it is linked to low-density lipoproteins (LDL), it is considered bad cholesterol, as it is this cholesterol that is deposited on the walls of the arteries; if it is linked to high-density lipoproteins (HDL), it is considered good cholesterol, as it is this cholesterol that is transported from the arteries to the liver in order to be reconverted.

DOES CHOLESTEROL COME FROM THE DIET?

Yes and no. If it is true that animal fats contain cholesterol, most of the cholesterol we have does not come from our diet, but is produced in the liver. This explains why there can be thin people with high cholesterol and obese people with relatively low cholesterol, and also why even a strict diet usually has little influence on our cholesterol value, unlike the significant impact that diet can have on our blood glucose. , weight and triglycerides, as all these parameters are mostly influenced by our diet and physical activity.

ARE CHOLESTEROL-LOWERING DRUGS DANGEROUS?

No, the medicines available in Portugal are subject to strict quality control and are only approved through demanding clinical trials. On the contrary, “natural” and “organic” products are not subject to any quality control or surveillance, they are usually expensive and, as their complete composition is not known or tested, they can lead to serious health problems.

CAN MEDICINES HAVE SIDE EFFECTS?

Yes, they can, but it is important to clarify several issues in this regard, starting with what can be considered a side effect. It is well known that statins can give muscle pain; Does this mean that if I’m taking a statin and I have muscle pain, is that a side effect of the statins? The answer is no! For muscle pain to be a side effect of statins, it has to have the following characteristics: it happens a few days after starting the statin or a new dose of statin, it happens in almost every muscle in the body, it disappears almost immediately after stopping the statin and reappear almost immediately upon restarting the statin.

From what has just been described, it is easily understood that muscle pain in a specific place in the body is not the fault of statins and should not lead to their reduction or suspension. On the other hand, joint or bone pain are not a side effect of statins, so they should not lead to their reduction or suspension.

AND WHAT SHOULD I DO IF I HAVE A REAL SIDE EFFECT FROM STATIN?

You should talk to your doctor as this side effect may not happen with another statin, and even if it does, you may be prescribed another medicine such as ezetimibe.

And don’t “natural” and “biological” products give muscle pain? Usually not, as they are not very potent (eg red yeast rice) or totally ineffective (placeboes do not usually cause side effects…). However, as in many cases their composition is not known or regulated, they may contain dangerous and even deadly substances…

HOW LONG DO I HAVE TO TAKE THE MEDICATION?

Since cholesterol is mostly produced in the liver and the liver is continually producing cholesterol, the medication has to be taken chronically, that is, for the rest of your life. If at any given time we reduce the dose of medication or stop it, cholesterol rises immediately, reversing all the benefits of medication taken in the past.