75% Of Heart Attacks Have Normal Cholesterol? Cardiologist Explains.

Summary

In this video, Dr. Alo, a cardiologist, debunks the myth that normal cholesterol levels preclude heart attacks. He explains that 'normal' levels are often too high, and emphasizes the importance of lowering LDL cholesterol to reduce atherosclerosis and heart disease risk. He also discusses the role of lipid-lowering therapy, genetic factors, and acute phase reactants in heart attacks, advocating for evidence-based understanding over unfounded conspiracies.

Takeaways

• 📊 Many people with heart attacks have 'normal' cholesterol because past guidelines considered higher levels as normal.
• ⚕️ Current guidelines recommend LDL cholesterol levels under 100 and total cholesterol under 150.
• 🔬 Lower LDL cholesterol consistently leads to less atherosclerosis, heart disease, and mortality.
• 📉 Even people with 'normal' LDL cholesterol (under older guidelines) can have significant plaque buildup.
• 👨‍⚕️ Some patients are already on lipid-lowering therapy, which affects their cholesterol readings.
• 📅 Cholesterol should ideally be kept low from a young age (20-50) to prevent atherosclerosis.
• 💊 Lipid-lowering therapy is often prescribed too late, after plaque buildup has already occurred.
• 📉 LDL cholesterol levels naturally drop during a heart attack, which can make them appear normal or low.
• 🚫 Triglycerides rise significantly during a heart attack due to acute stress, influencing lipid readings.
• 📚 Lowering LDL cholesterol is a well-established method to reduce the risk of heart attacks and strokes.

Q & A

Why do some people experience heart attacks despite having normal cholesterol levels?

Heart attacks can occur in individuals with normal cholesterol levels due to various factors such as the redefinition of 'normal' cholesterol levels, the presence of other risk factors like lipoprotein(a), late initiation of lipid-lowering therapy, and the body's stress response during a heart attack which can temporarily lower cholesterol levels.

What is the role of LDL cholesterol in heart disease?

LDL cholesterol is a significant factor in heart disease as it contributes to the formation of atherosclerosis. The lower the LDL cholesterol levels, the less likely an individual is to develop heart disease, as shown by various studies and trials.

What is the 'cholesterol years' concept mentioned by Dr. Alo?

The 'cholesterol years' concept is a method to estimate the risk of plaque buildup in arteries. It is calculated by multiplying a person's age by their LDL cholesterol level. A score above 5,000 indicates a higher risk of plaque formation.

Why have the guidelines for 'normal' cholesterol levels changed over time?

The guidelines for 'normal' cholesterol levels have changed due to accumulating evidence that shows lower LDL cholesterol levels are associated with reduced risk of heart disease. The current recommendation is to keep LDL cholesterol under 100 and total cholesterol under 150.

What is the significance of the PROVE IT-TIMI 22 trial in the context of heart attacks?

The PROVE IT-TIMI 22 trial demonstrated that administering high-intensity statin therapy (such as Lipitor 80) immediately upon hospitalization for a heart attack can significantly reduce mortality rates within the first 14 days.

How does lipid-lowering therapy impact cholesterol levels during a heart attack?

Lipid-lowering therapy, when administered promptly during a heart attack, can reduce LDL cholesterol levels by 35-60%, which is a significant drop that can help mitigate the severity of the heart attack.

What is the impact of acute stress on cholesterol and triglyceride levels during a heart attack?

During acute stress, such as a heart attack, cholesterol levels can drop by 20-40%, and triglyceride levels can rise by 15-25%. This is due to the body's stress response, which includes changes in lipid metabolism.

Why might some people have normal cholesterol levels after a heart attack?

Some individuals may have normal cholesterol levels post-heart attack due to the natural stress response that temporarily lowers cholesterol, the initiation of lipid-lowering therapy, or because their cholesterol levels were previously high and have now dropped to a 'normal' range.

What is the importance of early intervention with lipid-lowering therapy?

Early intervention with lipid-lowering therapy is crucial as it can prevent the buildup of plaque in the arteries over time. Waiting until later stages can result in atherosclerosis that is more difficult to reverse.

How does the script address the misinformation spread by social media influencers?

The script refutes misinformation by emphasizing the importance of evidence-based medicine, scientific data, and the consensus among medical professionals that high cholesterol is a well-established risk factor for heart disease.

What is the role of lipoprotein(a) in heart disease according to the script?

Lipoprotein(a) is a genetic factor that can significantly contribute to heart disease. It is more atherogenic than normal lipoproteins, and high levels of lipoprotein(a) can lead to heart attacks even in individuals with otherwise normal cholesterol levels.

Outlines

00:00

🧬 The Misconception of Cholesterol and Heart Attacks

Dr. Alo, a cardiologist, addresses the common myth that people with normal cholesterol levels cannot have heart attacks. He explains that the definition of 'normal' cholesterol levels has changed, with current guidelines recommending an LDL cholesterol under 100 and total cholesterol under 150. He emphasizes the importance of data and scientific evidence over conspiracy theories and highlights the role of cholesterol in heart disease, stating that lower LDL levels are associated with reduced risk of atherosclerosis and heart disease. The video is aimed at debunking misinformation and encouraging viewers to rely on scientific evidence.

05:01

💊 Lipid-Lowering Therapy and Its Timing

This paragraph discusses the issue of lipid-lowering therapy and its timing in relation to heart attacks. Dr. Alo points out that many people who experience heart attacks are already on such therapy, but it's often initiated too late. He mentions that guidelines often recommend therapy only after a certain risk threshold is crossed, which can result in years of atherosclerosis development. The paragraph also touches on the importance of early prevention and the benefits of lowering LDL cholesterol at a younger age, as supported by various medical professionals and studies.

10:03

📉 Cholesterol Levels During a Heart Attack

Dr. Alo explains the phenomenon of cholesterol levels dropping during a heart attack. He states that cholesterol levels can decrease by 20% to 40% in the acute phase due to stress-induced physiological changes. This can make it seem as though a person has 'normal' cholesterol levels at the time of a heart attack, even if they have had high levels for many years. The paragraph also discusses the rise in triglycerides as an acute phase reactant during a heart attack, and how this can mislead people into thinking that triglycerides, rather than cholesterol, are the primary cause of heart disease.

15:03

📚 Educational Resources and Community Engagement

In the final paragraph, Dr. Alo invites viewers to join his community for further education and discussion on cholesterol, heart health, and related topics. He mentions his book on cholesterol, which includes a chapter on the discussed topic, and offers a free trial for his community using a special code. The paragraph serves as a call to action for viewers to engage with accurate information and support networks to better understand and manage their health.

Keywords

💡Heart Attack

A heart attack, also known as a myocardial infarction, occurs when blood flow to a part of the heart is blocked, usually by a blood clot. In the video, the speaker discusses the common misconception that people with normal cholesterol levels cannot have heart attacks, which is a central theme of the video. The script mentions that 50-73% of people having heart attacks have 'normal cholesterol levels', challenging the viewer to reconsider what 'normal' means and the factors that contribute to heart disease.

💡Cholesterol

Cholesterol is a waxy substance that is essential for the body's functions but can become a health risk when there is too much of it in the blood. The video emphasizes the importance of understanding cholesterol levels in relation to heart health. The speaker, Dr. Alo, explains that 'normal' cholesterol levels have been redefined over time and that lower levels are now associated with better health outcomes, directly relating to the discussion of heart attacks in people with seemingly normal cholesterol.

💡LDL Cholesterol

LDL, or low-density lipoprotein, is often referred to as 'bad cholesterol' because high levels can lead to plaque buildup in the arteries, increasing the risk of heart disease. The video script discusses the changing guidelines for LDL levels, with the speaker stating that everyone should aim for under 100 mg/dL for LDL cholesterol, which is a departure from previous standards and is crucial for understanding heart health risks.

💡Atherosclerosis

Atherosclerosis is a condition where plaque builds up inside the arteries, which can restrict blood flow and lead to heart disease or stroke. The script uses atherosclerosis as an example of a process that can be influenced by cholesterol levels. It is mentioned that even people with 'normal' cholesterol levels can have atherosclerosis, which is a key point in the discussion about heart attacks and cholesterol.

💡Lipoprotein(a)

Lipoprotein(a) [Lp(a)] is a type of lipoprotein that can contribute to plaque formation in the arteries and is considered more atherogenic than LDL cholesterol. In the video, Dr. Alo mentions Lp(a) as a factor that might be elevated in individuals who have heart attacks despite having normal LDL cholesterol levels, highlighting the complexity of lipid profiles in heart disease risk assessment.

💡Lipid-Lowering Therapy

Lipid-lowering therapy, often involving the use of statin medications, is a treatment to lower cholesterol levels in the blood. The video script discusses how many people who have heart attacks are already on lipid-lowering therapy, which can affect cholesterol levels and how they are perceived in relation to heart health.

💡Acute Phase Reactants

Acute phase reactants are substances in the blood whose levels change in response to inflammation or other stresses on the body. The video explains that during a heart attack, levels of certain blood components, such as triglycerides, can increase as part of the body's stress response, which can affect how cholesterol levels are interpreted in the context of a heart attack.

💡Cholesterol Years

Cholesterol years is a concept introduced by Dr. Michael Shapiro, where a person's age is multiplied by their LDL cholesterol level to estimate the risk of plaque buildup. The script mentions this concept as a way to understand the long-term impact of cholesterol levels on heart health, with a cutoff of 5,000 indicating a higher risk for plaque formation.

💡Evidence-Based Medicine

Evidence-based medicine is an approach to medical practice that emphasizes the use of the best available evidence from well-designed and conducted research. The video script repeatedly refers to evidence-based medicine, urging viewers to look at data and science rather than believing in unfounded conspiracy theories about cholesterol and heart health.

💡Cardiologist

A cardiologist is a medical professional specializing in the diagnosis and treatment of heart diseases. Dr. Alo, the speaker in the video, identifies himself as a double board-certified cardiologist, which lends credibility to his discussion on cholesterol, heart attacks, and the factors contributing to heart disease.

💡Statins

Statins are a class of drugs that are used to lower cholesterol levels, particularly LDL cholesterol, and reduce the risk of cardiovascular events. The script discusses statins in the context of lipid-lowering therapy and their role in managing cholesterol levels to prevent heart attacks, as well as their administration during a heart attack to rapidly lower cholesterol.

Highlights

The common misconception that people with normal cholesterol levels cannot have heart attacks is debunked.

Online misinformation spread by grifters is criticized for promoting conspiracy theories over scientific evidence.

Dr. Alo, a double board-certified cardiologist, emphasizes the importance of data and science in understanding heart attacks.

Studies show 50-73% of people having heart attacks have 'normal' cholesterol levels, but 'normal' levels are now considered too high.

New guidelines recommend LDL cholesterol under 100 and total cholesterol under 150, reflecting the understanding that lower is better.

Lowering LDL cholesterol has been proven to reduce artherosclerosis, heart disease, and mortality.

The concept of 'cholesterol years' is introduced, where age multiplied by LDL cholesterol indicates plaque buildup.

PIEA trial results show that even with 'normal' LDL levels, a significant portion of people have subclinical atherosclerosis.

Many people having heart attacks are on lipid-lowering therapy, which can mask high cholesterol levels.

Lipoprotein(a) levels, not typically checked, can be a significant risk factor for heart attacks even with normal LDL levels.

The importance of starting lipid-lowering therapy early to prevent atherosclerosis is highlighted.

PROVE IT and TIMI 22b trials show immediate lipid-lowering therapy upon heart attack reduces mortality risk.

During a heart attack, LDL cholesterol can naturally decrease significantly, and triglycerides can increase due to stress.

The role of acute phase reactants in heart attack response is explained, affecting cholesterol and triglyceride levels.

The video encourages viewers to share this information to counteract common myths about cholesterol and heart attacks.

Dr. Alo invites viewers to join his community for further discussion and guidance on cholesterol and heart health.

Transcripts

why is it that most people having heart

attacks have normal cholesterol levels

every day on social media I get asked

this question why then why does most

people have normal cholesterol it's not

the cholesterol it's this it's that it's

the other thing so this is a super

simple question and answer the problem

is you've got these online grifters that

want to sell you a dream they want to

sell you some conspiracy that the whole

world is conspiring against you and that

it's not the cholesterol and it's some

Big Sugar big Pharma big government

conspiracy theory your doctors want to

keep you sick so that they can kill you

and keep profiting off of you and a

whole bunch of nonsense so how about you

just look at the data and the science

now if you're not convinced by data and

Science and you want to believe

conspiracies this is not the video or

the channel for you you are welcome to

go follow conspiracy theories and medf

fluenc who literally have no ideaa what

they're talking about if you don't know

who I am I'm Dr Alo I'm a double board

certified cardiologist I teach at two

different medal schools I teach

cardiology fellows every single day

these are future cardiologists and I've

taught at various medical conferences

around the country and world and online

through my various social media

platforms whether it's short form stuff

or these longer form videos so when

someone is having a heart attack they

can be divided up into two types of

people and if you do look at the studies

they do show that anywhere between 50

and 73% of people who walk through the

door have't having a heart attack have

quote unquote normal cholesterol levels

now the problem with this is first of

all the normals are too high

previously we used to think that an LDL

cholesterol of 130 was normal and a

total cholesterol of up to 200 was

normal these guidelines have changed in

2018 we want everyone under 100 for LDL

cholesterol and under 150 for total

cholesterol now why did this change

because the data is there the lowerer

your LDL cholesterol regardless of how

you lower it whether it was done through

you know genetic mutations whether we

lowered it with medications whether you

lowered it with diet whether you low

lowered it with lifestyle exercise

randomized control trial Trials of

medications whatever it is however you

lowered your LDL cholesterol we know

that the lower the LDL cholestrol and

you know I'm going to put all the

graphics up here if you're listening on

audio format highly recommend you watch

the video version of this on YouTube

but if you have lower LDL cholesterol

you have less artherosclerosis less

heart disease Le less death less all

cause mortality less pretty much

everything and the data is pretty clear

on that I don't think that's debatable

if you want to debate it we have a

problem you are basically telling me you

are anti-science and anti- evidence but

we know that at an LDL cholesterol of

about 60 milligram per deciliter or

higher most people are probably laying

down plaque and we now believe in this

thing called cholesterol years Dr

Michael Shapiro published on cholesterol

years if you multiply your age by your

LDL cholesterol that is called

cholesterol

years a 40-year-old person who has had

LDL cholesterol of 125 125 * 40 That's

5,000 the cut off is about 5,000 over

5,000 you have plaque below 5,000 you

are you have plaque it's just not as bad

yet so we know that about 60 milligrams

per leader is about the cut off of where

uh people start laying down plaque now

this was shown in the piea trial the

prevention of early subclinical

atheroslerosis this was young people

with no other risk factors no metabolic

syndrome no obesity no calcium no

insulin resistance you know Super Active

lean people you know average age I think

median age was like 40 so like half the

people were younger than that and they

looked at just their LDL cholesterols

people who had a normal LDL of 110 at

the time that was normal 54% of them or

I'm sorry 45% of them had

atherosclerosis if you go to 130 nor

normal 130 you had a 54% of those people

had aerosis if you go up to

150 you had uh 68% of people almost 70%

of people had artherosclerosis it was

not yet clinical it was subclinical it's

still not giving you symptoms it's just

brewing in your arteries the word first

part about it is

that of those people that had

atherosclerosis 63% of them had it in

more than one arterial bed meaning you

didn't just have it in your cids you had

it in your femorals and your coronaries

and your kidneys you know wherever all

these coronary beds the arterial beds

that they measured you had it there so

that's one thing the normals were just

too high so people say well most people

70% of people having heart attacks uh

had nor had normal cholesterol so first

of all the normals are High I guarantee

you by today's standards that would not

be the case now the other part is

that some of these people were on lipid

lowering therapy the vast majority of

people who have heart attacks are men

are usually in their 50s and 60s women

60s and 70s and then end up so you know

55 and up on the men's side 65 and up on

the female side now of course there are

people have really high LDL cholesterol

much earlier you know have heart attacks

in their 30s and 40s the familial

hypercholesterol Olia people have super

you know High genetic cholesterol or

lipoprotein a the other thing that these

studies don't check is lipoprotein a

somebody may have had a normal LDL let's

say it's like really low let's say it's

like 80 you know 70 their LDL 70 but

they had a heart attack well their

lipoprotein a is greater than 600 and if

you watch my lipoprotein a lecture on

here you know that that is 3 to six

times more arthrogenic than normal

lipoproteins and there's visuals and

there's Graphics I really recommend you

check that one out

so many of these people are already on

lipid lowering therapy but the problem

is in the United States and in other

places we don't put people on lipid

lowering therapy till it's too late most

people are not going to put a

40-year-old on lipid lowering therapy if

their LDL is 110 120 130 they might not

even put a 50y old because of the 10

year risk calculators that we've always

been taught to use and a lot of the

electronic medical records now have

those built in your risk of a heart

attack over the next 10 years might be

3% and it's not going to recommend you

know lipid lowering therapy finally when

you cross that threshold of 75% then

it'll recommend it but you've had like

40 or 50 years of atherosclerosis

building up if your LDL is above 60

milligrams per deciliter You're Building

plaque if your cholesterol years adds up

to more than 5,000 you could even argue

three to 3 to 4,000 you have

plaque so now you have all this plaque

you finally get put on lipor and then a

few years later you have a heart attack

but your LDL is like 70 because you're

on lipor and they told you you need to

be under 100 now so is another

contributor of those 70% of people that

are having heart attacks with normal

cholesterol it's because a lot of them

got put on lipid lowering therapy too

late also Michael Shapiro Peter Toth and

even Dr dpring and a few other people

they wrote this wonderful article and it

was called that we need to try to

prevent atherosclerosis much earlier

they said that if you had a choice of

lowering your LDL cholesterol for 30

years only would you rather have it

lower between the ages of 20 and 50 or

between 50 and 80 they all said it would

be between 20 and 50 if you had if you

could pick having an LDL cholesterol of

let's say 50 for 30 years you would want

it to be those 30 years between the age

of 20 and 50 as opposed to 50 to 80

Because by the time you're 50 you have

so much plaque we're just trying to

piece you back together again so keep

that in mind of the cholesterol of the

lipid lowering therapy naive people

people are not on statins not on

medications what happened with those

people when you kind of split those out

in the studies when somebody has a heart

attack it is in the guidelines that you

have to put a lipor 0 in their mouth the

second they walk through the door most

academic centers most places who do

guideline you know treatment therapy the

prove it trial it's called prove it P R

O v-it prove it trial or Timmy 22b trial

demonstrated that if you give somebody

lipor 80 the second they walk through

the door their risk of mortality goes

down by 16% or I think it was repeat CV

events I think no I think it was

mortality CV mortality maybe um goes

down by 16% even within those first 14

days that's why it's important and made

it into the guidelines where the second

somebody walks in they get it Lipitor 80

so that will drop most people's LDL

cholesterol anywhere between 35 to maybe

50 50% so or now they do recommend also

Crestor 40 you know high intensity

statins you know atorva Statin or rosu

stattin Crestor or Lipitor Crestor 40

which is the higher dose will drop most

people's lipid levels anywhere from like

as low as 35% up to maybe 60% in some

people so you're getting an immense

amount of lipid lowering the second you

walk through the door but then they

looked at all comers who did not get any

lipid lowering therapy who were not

already on lipid lowering therapy and

they went back and they looked at what

happens to people's ldls their hdls

their triglycerides and all of that the

second you know they are having a heart

attack

they found that on day one so they found

that over those first nine days most

people's LDL cholesterol dropped

anywhere

from 15 20% up to like 40 to 50%

depending on the person depending on

their genetics Etc so you automatically

had like a 10 to 30 milligram per

deciliter drop in your LDL so let's say

your LDL was 110 or let's say it was

like 130 now all of a sudden it's like

90 oh it's normal it's normal but they

had a heart attack well it's been like

130 for for 40 50 years right 55 years

um the other scenario is somebody who's

LDL cholesterol hovers around 90 uh

which is or I'm sorry hovers around 110

and now they come in and it drops by

like 20 milligrams now they're around 90

right so those scenarios happen they

found that on day one most LDL drops by

about 9% triglycerides go up by about

177% and then by day four 5 7 8 9 and

I'll put the the graphics up here like

maybe on this side somewhere um these

are all Graphics from my cholesterol

book there's a whole chapter on this why

do most people have heart attacks have

normal cholesterol because Studies have

shown that 52 73% of people who walk

through the door have normal quote

unquote cholesterol normal defined how

however you want to Define it whether

they're on lipid lowering therapy

whether they're on they're stat and

naive whether they were normal by the

old guidelines or normal by the old ways

or just actually just normal based on

today's guidelines so it's a whole

chapter in my cholesterol book if you go

to Dr all.net cholesterol you can read

all about it get some previews look at

the chapters look at the beautiful

graphics and this is an entire chapter

out of that book but I'll put the

graphics from that book uh right here so

you do have a concominant rise in

triglycerides it's an acute phase

reactant triglycerides will go up when

you're under severe stress like

something like a heart attack so a lot

of these Med fluenc and social media you

know nonsense Peddlers will say oh it's

not the cholesterol it's the

triglyceride when every single study

we've done that has lowered

triglycerides in and of itself by

themselves has not shown benefit whereas

if there came with it a lowering of apob

or LDL cholesterol then there was a

benefit that tracked with the lower uh

apob the lower the apob the more benefit

just like in any other trial regardless

of triglycerides regardless of HDL

regardless of anything else the more you

lower AO be regardless of anything else

the less risk you you have so those are

the reasons why when somebody walks

through the door they may or may not

have abnormal or high cholesterol they

may be on lipid lowering therapy they

may have some genetics um they may have

gotten a Crestor 40 or lipor 80 when

they walk through the door they may have

been abnormal based on the old

guidelines you know it just there's a

lot of reasons why this happens plus

when you're having a heart attack your

numbers drop by as much as like 40%

sometimes um actually not sometimes in

the studies 40% decrease 20 to 40%

decrease in LDL cholesterol with a 15 to

maybe 20 25% increase in triglycerides

acute phase reactants this is welln your

thyroid is off your uh cortisol hormones

are off your you know adrenocorticoids

like everything there's a whole phase of

these things called acute phase

reactants that increase and or decrease

when you are under immense stress like

you're septic you're having a heart

attack you're fighting off cancer you

know whatever it might be there's this

whole host of things called acute phase

reactants so

send this video to somebody who needs to

hear this because there's a lot of

people out there that think literally if

you have normal cholesterol you can

still have a heart attack when we know

that over time based on all of the data

the lower your LDL cholesterol the for

the longer for the most amount of years

the less the impro the probability of

you having a heart attack or stroke this

is not like debatable this is like

there's a lot of things in science that

we still could question and wonder about

this is not one of them high cholesterol

in was was demonstrated in

1913 when you infused rabbits or humans

or any other way with high high

lipoproteins or fed them a high

saturated fat diet or high cholesterol

diet even they had fatty streaks within

hours um especially when you infused

lowdensity lipoproteins into people

fatty streaks developed within hours not

people I think that one was rabbits but

either way I think you guys get the

point this is one of these very

wellestablished medical things there's

always going to be influencers out there

trying to fool you we don't know why you

know like I said a lot of times people

just want to feel safe and they feel

like something is out to get you there's

this mystical magical thing out there

that has more power than you and that

that is why um this happen so this is

absolutely not true there's no such you

know superpower that does this yes

people who walk through the door may

have normal or even low levels of

cholesterol for any number of reasons

they may have already been on lipid

lowering therapy they may have gotten

lipid lower therapy the second they got

to door or it's an acute phase reactant

and they're reacting to the stress that

they are under if you like stuff like

this join my community Dr all.net

Community we talk about this every

single day through the app you can talk

to me text me shoot me your lipids shoot

me your CT scans coronary scores um we

do a weekly live Zoom meeting uh every

Monday night you can ask me questions

live it's super fun me and my friends

will help guide you through your weight

loss Journeys longevity cholesterol

lipids all that stuff and it's a lot of

fun um if you're use the code one month

you will get in for free cancel anytime

nobody would know try it out see if you

like it if you do awesome if not no big

deal it's not for you it's for someone

else anyways I'll catch you in the next

episode please send this to people who

need to know how this works