The medical establishment in the U.S. has been professing benefits of controlling cholesterol since 1985, because of research linking cholesterol to atherosclerosis and coronary artery disease (1). Short sighted, however, is the regard to these diseases as based completely on excess cholesterol as often assumed (2-3).
New research has proved that an assay of C-reactive proteins in the blood can predict coronary artery events (2). The higher C-reactive proteins are in the blood, the higher risk of an event and less likelihood of survival from the event (2). The C-reactive proteins, which increase during inflammation, suggest heart disease itself is an inflammatory condition (2).
If inflammation is the cause of heart disease, then inflammation should be the target of therapy, but it's important to not forget the link between cholesterol and heart disease. The atherogenic nature of LDL cholesterol in the arteries (now considered an independent factor to heart disease) leads to oxidation of LDL, which produces low-grade inflammation (2-3)! LDL is still partly to blame. Further, these findings bring oxidative stress in as a factor.
There are also many other causes of low-grade inflammation associated with coronary artery disease such as smoking, high blood pressure and hyperglycemia (2). These also produce oxidation of LDL. In fact, those with insulin resistance due to hyperglycemia also show an increased amount of oxidized LDL (4).
My opinion on heart disease is formed by all the different sides. Moving a patient from a pro-inflammatory state to a healthy state requires medical treatment and diet designed to take in all factors. These should include levels of C-reactive proteins, LDL cholesterol, oxidation of LDL cholesterol and other causes of inflammation.
References
1. FDA. Available at: http://www.fda.gov/bbs/topics/CONSUMER/CON00052.html
2. AHA. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4648
3. AHA. Atherogenic lipoprotein particles in atherosclerosis. Available at http://circ.ahajournals.org/cgi/content/full/109/23_suppl_1/III-2
4. Scazzocchio B, Varì R, D'Archivio M, Santangelo C, Filesi C, Giovannini C, Masella R. J Lipid Res. 2009 Jan 9. [Epub ahead of print] Links
Oxidized low-density lipoproteins impair adipocyte response to insulin by activating serine/threonine kinases. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19136667?ordinalpos=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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