Mar 14 2009

Cholesterol II

When I wrote about my cholesterol numbers a while back, I looked around for a graph showing studies correlating deaths to cholesterol levels.  I thought I’d seen one somewhere, but couldn’t find it, and didn’t have the time to build one from the numbers myself.  Well, I found one at Hyperlipid, in a very good post on the way the study results were slanted to give us the cholesterol myths and billion-dollar anti-cholesterol drug business we have now.  I cropped out the graph:

Deaths and CHD "events" versus total cholesterol

Deaths and CHD "events" versus total cholesterol

If you don’t have time to go read the whole post, here’s a summary.  The green line is the one that’s been used to scare the heck out of everyone and sell statins by the boatload by pushing them on everyone with a total cholesterol number over 180.  It comes from a big study that compared heart disease “events” (not necessarily deaths) against total cholesterol in middle-aged men.  As you can see, men with total cholesterol over 210 or so tended to have more of these events.  However, they didn’t correct for other factors that have a huge effect on heart health, like smoking; and even if they had, this still only shows correllation, not causation.  In other words, just because two things seem to increase together, that doesn’t mean one causes the other; they could both be caused by the same third factor.

Now, the purple line is the one I was looking for last time.  It comes from another big study of middle-aged men and shows total deaths, not just those from heart issues.  Unless you think death from a heart attack would somehow be worse than some other kind of death, this study is much more useful than the first one.  As you can see,  deaths start climbing below 170 at an even sharper rate than they do above 220.  Because of the green line, we’re told that any number over 180 is worrisome, and the lower it is the better.  But the purple line shows that the ideal range is about 170-210, the center of which would be 190.  Much lower than that is definitely not better.

Now here’s another chart from that same post:

IHD events versus HbA1c

IHD events versus HbA1c

IHD (ischemic heart disease) is the fancy term for blockage in the arteries, so it accounts for most heart attacks and is considered the most common cause of death in civilized countries.  HbA1c is a measurement of glycosylated hemoglobin, which tells you how much sugar is floaing around in your blood.  It’s a bit more accurate and provides more information than the do-it-yourself finger-prick testing you can do at home, but the results match up pretty closely. So this compares the most common heart disease to blood sugar levels.

Where risk really starts climbing on this graph, a little above 6, corresponds to about 120-130 on a home blood sugar test.  Interestingly, some research says damage to the pancreas starts happening at 120.  The American Diabetes Association and most doctors will tell you numbers as high as 140 (about 6.7 on this chart) are no big deal; but look how fast the risk is climbing at that point.  Someone with bad blood sugar control who isn’t low-carbing can easily hit 8+ for a couple hours after each meal, which doesn’t even fit on this chart.

Again, this is still only correlation; none of this proves causation.  But compare those two graphs, and then ask yourself: should you worry more about your total cholesterol level or your blood sugar level?

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