Cholesterol – The “Magic” 200 Number and the Overprescribing of Statins

BY ENDURANCE NEWS STAFF

Explanations, standard ranges of cholesterol numbers, and healthy level ranges of cholesterol numbers:

Total Cholesterol is a measure of the total amount of cholesterol in your blood. It includes both low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.

• Total Cholesterol standard range: 0 - 200 mg/dL
• Total Cholesterol healthy level range: 125 - 199 mg/dL
• Borderline high: 200 - 239 mg/dL
• High: at or above 240 mg/dL

HDL (good) cholesterol – HDL helps remove cholesterol from your arteries.

• HDL Cholesterol standard range: 40 - 90 mg/dL (women) -- 50 mg/dL (men)
• HDL Cholesterol healthy level range: 40 mg/dL or higher (women) -- 50 mg/dL or higher (men)

LDL (bad) cholesterol – The main source of cholesterol buildup and blockage in the arteries.

• LDL Cholesterol standard range: 0 - 130 mg/dL
• LDL Cholesterol healthy level: Less than 100 mg/dL

Non-HDL Cholesterol – This number is your total cholesterol minus your HDL. Non-HDL includes LDL and other types of cholesterol such as VLDL (very-low-density lipoprotein).

• Non-HDL standard rage: 0 - 159 mg/dL
• Non-HDL healthy level: Less than 130 mg/dL

Triglycerides – A form of fat in your blood that can raise the risk for heart disease.

• Triglycerides standard range: 0-150 mg/dL
• Triglycerides healthy level: Less than 150 mg/dL

Total Cholesterol to HDL-C: Total Cholesterol to HDL-C (HDL Cholesterol).

• Total Cholesterol to HDL-C standard range: 0.0 – 5.0
• Total Cholesterol to HDL-C healthy level range: under 3.5

Better predictors than the “magic” 200

Research [1] suggests that the Total Cholesterol to HDL-C ratio may be the most important factor in determining “cholesterol health.” Therefore, if one’s HDL (“good”) cholesterol is the higher range of “healthy levels (ex: 75) compared to a fairly high LDL (“bad”) cholesterol number (ex: 120), it will still be in an ideal Total Cholesterol to HDL-C level.

Another marker that is more reliable in determining cardiovascular disease risk (heart attack and stroke) than Total Cholesterol, is the ratio of Triglycerides (TG) to HDL (“good”) cholesterol, or TG:HDL Research [2] has shown that those with the highest ratio of triglycerides to HDL cholesterol have 16 times the risk of heart attack as those with the lowest ratio of triglycerides to HDL.

To obtain the ratio, divide the TG number by the HDL number.

Example:

• TG is 100
• HDL is 80
• 100 divided by 80 = 1.25

Ideal – TG:HDL is 2 or less
Healthy – TG:HDL is 3
High – TG:HDL is 3.5 is high
Too High – TG:HDL is 6 or greater

Sadly, so many still stuck on the “magic” 200

Unfortunately, there are many health care professionals who continue to look only at Total Cholesterol numbers as the primary risk factor for heart disease. They will often suggest that patients whose Total Cholesterol level is even slightly over the ideal limit of 199 mg/dL begin a regimen of statin medications.

And that’s a big problem.

For high-risk individuals, statins medications can provide significant benefits for lowering LDL cholesterol, but when prescribed as a preventative for low-risk individuals:

• Those whose Total Cholesterol to HDL-C ratio is ideal at under 3.5
• Those whose Triglycerides to HDL Cholesterol ratio is 3 or less
• Those whose Total Cholesterol is above the “magic 200 number” and the low-borderline range (ex: 210 mg/dL)

… statin’s side effects clearly outweigh the benefits. [3] Dr. Bayne French elaborates:

There is certainly something powerful biologically going on with statin medications. In addition to lowering cholesterol, they lower inflammation and act as antioxidants. [However], to say that they are universally beneficial and indicated for everyone with elevated cholesterol is grossly inaccurate. Statins likely help reduce CVD in certain situations. Like men under 70 who have already had a heart attack, and men with numerous risk factors (elevated blood pressure, abdominal obesity, diabetes, smoking, etc.). As Abramson et al (BMJ. 2013) reported, for the majority of people for which statins are prescribed (specifically for "primary prevention," people who DO NOT have heart disease), the benefit is lacking, while side effects and risks are significant. [4]

Side effects associated with statin medications

Here are but a few of the side effects—some are obviously quite serious—that may be experienced while on statin medications:

• Fatigue
• Headache
• Memory issues such as confusion, forgetfulness, confusion, and a decreased ability to process information
• Increased blood sugar levels and type 2 diabetes
• Stomach issues such as nausea and diarrhea
• Muscle pain
• Liver and kidney damage

While some of these side effects are considered rare, why flirt with the potential for them to occur if a statin medication isn’t truly needed?

Additional statin issues

It is well known that statins deplete the body’s levels of Coenzyme Q10 (CoQ10), perhaps the most important nutrient for human health. CoQ10 is classified as ubiquinone, from the word “ubiquitous,” because it is present in every cell in the body, CoQ10 produces ATP (energy) at the cellular level, energy that the body requires to stay healthy and optimize all its functions.

Nutritional scientists are universally in agreement about the importance of CoQ10; here are just a couple comments:

• "Without CoQ10 or a good substitute, human life quickly ends." - James South MA
• “That CoQ10 plays a crucial role in aging is beyond doubt. The same applies to CoQ10's role in the immune system. And there is a vital connection between the immune system and aging that cannot be ignored.” - Emile G. Bliznakov MD
• "CoQ10 is energy on call. I have long considered CoQ10 a wonder nutrient because of its ability to support heart health.” - Dr. Stephen Sinatra
• “Ubiquinone (CoQ10) is possibly the hub around which life processes revolve in the human body.” - Dr. William V. Judy

It’s clear that CoQ10 is essential for life, yet many who take statin drugs are not made aware of their negative impact on CoQ10 levels—statin side effects increase with decreased bodily levels of CoQ10—and are thus not taking this all-important nutrient.

It is also believed that statin medications may interfere with the synthesis of vitamin K2, which, in tandem with vitamin D3, is crucial for supporting both bone and cardiovascular health. Vitamin K2 activates a protein called osteocalcin, which helps keep calcium out of the arteries while increasing the amount of calcium in the bones (teeth as well). Vitamin K2, working alongside vitamin D3, also promotes healthy glucose metabolism to maintain proper blood sugar levels thus helping protect against type 2 diabetes.

Natural strategies to maintain optimal cholesterol levels

1) Diet first. The most important thing is addressing the diet and correcting dietary errors, primarily excess intake of omega-6 fatty acids.

2) Consistent exercise. Master athletes are reported to have lipid profiles similar to young adults, decreasing their risk of heart disease.

3) Supplementation. A number of nutrients/substances are reported to help lower elevated cholesterol levels, including Coenzyme Q10, the essential fatty acids EPA and DHA, probiotics, and more

More details about all three strategies are found in the article "Lower Cholesterol Levels By Up to 30%".

Summary

With one in four deaths in the US linked to cardiovascular disease [5], it’s nothing to brush off. However, many individuals rely too heavily on medications to lower their risk instead of making important and lifestyle changes, ones that provide only benefits and no side effects.

Statin medications are among the most commonly prescribed medications for treating high cholesterol, with annual sales in the billions of dollars [6]. For some individuals, statin medications have been proven to be effective; however, research suggests that statins are being overprescribed and should only be used for high-risk individuals [7, 8].

We aren’t disregarding the need for statin medications; for those high-risk individuals they can be very beneficial. However, because there are some serious risks associated with these types of medications, and because it’s suggested that they are overprescribed to begin with, we believe that those who at or slightly above the “magic 200 number” in terms of total cholesterol should at least consider adopting more-natural strategies instead of simply reaching for statin medication.

As Dr. Andrew M. Freeman states, referring to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, “Lifestyle, in the form of diet, exercise, stress relief, and connection and support with others, is nature’s best way to improve overall health, including cardiovascular health. We know that making dietary interventions, combined with exercise, can sometimes lower cholesterol as effectively, or even more effectively, than statins.”

REFERENCES:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747394/
[2] Gaziano JM, Hennekens CH, O’Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997 Oct 21;96(8):2520-5.
[3] https://www.thennt.com/nnt/statins-for-heart-disease-prevention-without-prior-heart-disease-2/
[4] https://hammernutrition.com/blogs/endurance-news-weekly/lipids-a-different-perspective-part-3
[5] https://www.cdc.gov/heartdisease/facts.htm
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108295/
[7] https://www.acpjournals.org/doi/10.7326/M18-1279
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857879/