Newsletter August 2022 – Early heart disease among people with familial hypercholesterolemia (FH) is not caused by their LDL-cholesterol

Together with a number of international experts I have demonstrated that high LDL-cholesterol (LDL-C) is beneficial; it is not the cause of atherosclerosis and cardiovascular disease (Ref. 1). Hitherto it has been downloaded by almost a quarter of a million readers, but nothing happens. According to the official guidelines, cholesterol should be lowered as much as possible: in particular in high-risk individuals and those with inherited high cholesterol (FH: familial hypercholesterolemia). But as you will see in the following, nothing is in accord with the cholesterol hypothesis:

1. People with low LDL-C are just as atherosclerotic as people with high LDL-C (Ref. 1).
2. At least 35 follow-up studies have found that elderly people with high LDL-C live just as long or longer than elderly people with normal or low LDL-C. (Ref. 2; Ref. 3).
3. No cholesterol-lowering trial have shown an association between the degree of cholesterol-lowering and the outcome (exposure-response); the minimal benefit is
   the same whether cholesterol is lowered very much or only a little. (Ref. 1).
4. LDL-C of patients with acute myocardial infarction is lower than normal (Ref. 1)
5. The number of serious side effects from statin treatment is very high but they are ignored by the drug companies (Ref. 4) because their conclusions are based on misleading statistics, exclusion of unsuccessful trials and by ignoring numerous contradictory observations.

A relevant question is therefore: How come that people with FH die early from a heart disease? The answer is, that it is very few who die prematurely and that it is not caused by their high LDL-C, but by high coagulation factors which a few of them have inherited as well. In our recently published paper (Ref. 5) you can find the references to the following facts:

1. As among other people, several studies have shown that LDL-C of people with FH is not associated with the degree of atherosclerosis.
2. Several studies have shown that people with FH live on average just as long as other people. For more than 100 years ago when infections was the commonest cause of death, their life was even longer.
3. FH people with the highest LDL-C values live just as long as those with the lowest values.
4. Neither cardiovascular or total mortality is associated with their LDL-C.
5. No cholesterol-lowering trial including FH people only, have been able to lower the risk of cardiovascular disease.
6. The few who suffer prematurely from cardiovascular disease have inherited elevated levels of various types of coagulation factors.
7. In a study of several FH families, men with FH lived to virtually the same age as their relatives without FH, and women with FH lived six years longer than those without.

 References

1. LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature.
2. Lack of an Association or an Inverse Association Between Low-Density-Lipoprotein Cholesterol and Mortality in the Elderly: A Systematic Review
3. The LDL Paradox: Higher LDL-Cholesterol is Associated with Greater Longevity
4. How statistical deception created the appearance that statins are safe and effective in primary and secondary prevention of cardiovascular disease
5. Importance of Coagulation Factors as Critical Components of Premature Cardiovascular Disease in Familial Hypercholesterolemia

Uffe Ravnskov
ravnskov.nu