난 니가 콜레스테롤에 한짓을 알고있다 [LDL과 심혈관질환 2편]

닥터쓰리 - 한미일의사의 쉬운 의학

16 Jun 202317:00

Summary

TLDRThis video script challenges the conventional wisdom about cholesterol, suggesting that high cholesterol is not the main culprit in heart disease. It discusses various studies, including Framingham Heart Study findings, which indicate that other factors like triglycerides and the ratio of total cholesterol to HDL might be better predictors of heart attack risk. The script also raises concerns about the influence of pharmaceutical companies on research and the potential side effects of cholesterol-lowering drugs, advocating for a more evidence-based approach to medicine.

Takeaways

📉 The proportion of people with high cholesterol in the United States has been decreasing, yet the number of deaths from heart disease is increasing, raising questions about cholesterol's role as the main culprit of heart disease.
🏥 The Framingham Heart Study has been influential in heart disease research, with thousands of studies published on cardiovascular diseases and their risk factors, shaping medical understanding of heart health.
🔍 The total cholesterol to HDL ratio and the presence of triglycerides have been found to be better predictors of heart disease than LDL cholesterol alone, challenging the focus on LDL as the primary indicator.
⚠️ A 30-year observational study from the Framingham Heart Study showed that for every 1 mg/dL decrease in cholesterol, there was an 11% increase in overall mortality and a 14% increase in cardiovascular mortality, contradicting common beliefs.
💊 Pharmaceuticals, including some cholesterol-lowering drugs, have been associated with negative side effects and controversies, such as the Vioxx scandal, which highlighted the importance of transparency in clinical trials.
🧪 The presence of fluorine in medications and everyday products, such as toothpaste and non-stick pans, has raised concerns due to its potential health impacts, including links to decreased IQ in children and disrupted sleep patterns.
🌐 International research, including studies from Canada, Guatemala, India, and Australia, has shown no correlation between arterial sclerosis and blood cholesterol levels, further questioning the cholesterol-heart disease hypothesis.
📊 Data from Japan's Fukuoka city shows that the lowest mortality rate from cardiovascular diseases was not in the group with the lowest cholesterol levels but rather in those with cholesterol levels between 240 and 259 mg/dL.
🚫 The script criticizes the medical community for blindly accepting the theory that lowering LDL cholesterol is beneficial, suggesting that this belief may be outdated and not supported by recent evidence.
🛑 The potential risks of lowering LDL cholesterol too much, such as increased risk of stroke, especially in the case of brain hemorrhage, are highlighted, indicating that very low levels of LDL may not be safe.
🌐 The script calls for a reevaluation of the 'cholesterol hypothesis' and a return to evidence-based medicine, emphasizing the need for independent, unbiased research in the field of cardiology.

Q & A

What is the trend of cholesterol levels and heart disease mortality in the United States according to the video?
-The video states that while cholesterol levels in the United States are decreasing over time, the number of heart disease deaths is actually increasing, which contradicts the common belief that high cholesterol directly leads to heart disease.
What is the Framingham Heart Study mentioned in the video, and what is its significance?
-The Framingham Heart Study is a renowned longitudinal study conducted in Framingham, Massachusetts, that has been analyzing cardiovascular disease and its risk factors since 1948. It has contributed significantly to the understanding of heart disease, and it is well-known among physicians.
What does Dr. William Castelli, the former director of the Framingham Heart Study, suggest about LDL cholesterol and heart disease risk?
-Dr. Castelli suggests that LDL cholesterol alone cannot predict the risk of coronary artery disease unless the numbers are above 300. The total cholesterol to HDL ratio and the LDL to HDL ratio are better predictors of heart disease than LDL levels alone.
What findings did the Framingham Heart Study report regarding the relationship between cholesterol levels and overall mortality rates?
-The Framingham Heart Study found that for every 1 mg/dL decrease in cholesterol levels, overall mortality rates increased by 11%, and cardiovascular mortality rates increased by 14%, which is contrary to the common belief that lower cholesterol levels are always better.
What was the outcome of the study comparing LDL cholesterol levels and 3-year all-cause mortality rates in patients admitted for myocardial infarction?
-The study found that patients with LDL levels above 105 had a 7.1% mortality rate, while those with LDL levels below 100 had a 14.8% mortality rate, indicating that lower LDL levels were associated with a higher mortality rate.
What did the autopsy study by New York pathologists reveal about the relationship between cholesterol levels and atherosclerosis?
-The study found no correlation between cholesterol levels and the frequency or severity of atherosclerosis in people who died suddenly from accidents or suicides, challenging the notion that high cholesterol is a direct cause of heart disease.
What is the controversy surrounding the use of statins and their potential side effects as discussed in the video?
-The video discusses concerns about the side effects of statins, such as sleep disturbances and cognitive issues, and mentions that some studies have suggested a link between fluoride, a common component in some medications and toothpaste, and potential negative health effects, including lower IQ in children.
What is the significance of the 'Vytorin scandal' mentioned in the video?
-The Vytorin scandal refers to an incident where the pharmaceutical company Merck allegedly withheld publication of study results that showed Vytorin, a cholesterol-lowering drug, did not reduce arterial wall thickness despite significantly lowering LDL levels, leading to questions about the drug's safety and efficacy.
What does the video suggest about the reliability of medical research funded by pharmaceutical companies?
-The video suggests that research funded by pharmaceutical companies may be biased towards positive outcomes for their products, and it calls for independent evaluation of drugs to ensure transparency and accuracy in medical research.
What is the controversy regarding the guidelines for prescribing statins by the American Heart Association as presented in the video?
-The video criticizes the guidelines for prescribing statins by the American Heart Association, suggesting that they may not be based on sound scientific evidence and could be leading to the over-prescription of these drugs to individuals at low risk of heart disease.
What evidence does the video present about the potential risks of lowering LDL cholesterol levels too much?
-The video presents evidence from various studies suggesting that excessively low LDL cholesterol levels may be associated with increased risks of stroke and other health issues, challenging the common goal of aggressively lowering LDL levels.

Outlines

00:00

📊 Cholesterol and Heart Disease Trends

This paragraph discusses the paradoxical trend in the United States where, despite a decrease in high cholesterol levels over time, the number of heart disease deaths continues to rise. It highlights the Framingham Heart Study, which has significantly contributed to cardiovascular research since 1948. The study emphasizes that the ratio of total cholesterol to HDL, rather than LDL alone, is a better predictor of heart disease. The paragraph also presents findings that challenge the conventional wisdom that high cholesterol is the main culprit of heart disease, suggesting that other factors, such as neutral fat, may play a more significant role.

05:01

🚫 The Controversy of Fluoride and Health Risks

The second paragraph delves into the potential health risks associated with fluoride exposure. It mentions a study that links increased fluoride levels in urine during pregnancy to a decrease in children's IQ scores. The paragraph also discusses how fluoride can accumulate in the pineal gland, potentially leading to conditions such as insomnia and other sleep disorders. It raises concerns about the presence of fluoride in various medications and everyday products, and how it might contribute to arterial sclerosis and other health issues, including brain vascular diseases.

10:02

💊 The Impact of Pharmaceutical Marketing on Health Research

This paragraph examines the influence of pharmaceutical marketing on health research, particularly in the context of cholesterol-lowering drugs. It discusses the case of Vioxx, which was linked to approximately 60,000 deaths due to heart attacks, and how the FDA was aware of the cardiac risks associated with the drug. The paragraph also addresses the issue of research bias, where studies funded by pharmaceutical companies tend to favor the sponsor's drug, and calls for greater transparency and independent evaluation of drug safety and efficacy.

15:03

🧬 The Misunderstanding of LDL Cholesterol's Role in Health

The final paragraph challenges the prevailing view that lowering LDL cholesterol levels is always beneficial for health. It presents evidence suggesting that very low levels of LDL cholesterol may actually increase the risk of stroke and other cardiovascular events. The paragraph criticizes the medical community for blindly accepting the theory that lower LDL levels are always better and calls for a return to evidence-based medicine. It also highlights the importance of considering other factors, such as the Framingham Risk Score, when assessing cardiovascular risk.

Mindmap

Keywords

💡Cholesterol

Cholesterol is a waxy, fat-like substance that's essential for the body's functioning, including the production of hormones and vitamin D. In the video, it's discussed as a controversial factor in heart disease, with the script suggesting that high cholesterol levels are not necessarily the main culprit for heart problems. The video challenges the conventional wisdom that lower cholesterol is always better, citing studies that show no correlation between cholesterol levels and heart disease mortality.

💡Framingham Heart Study

The Framingham Heart Study is a long-term, ongoing cardiovascular study that began in 1948. It's one of the most influential studies in the field of cardiology. The video mentions this study as a significant contributor to the understanding of cardiovascular diseases, indicating its role in shaping medical guidelines and the perception of cholesterol's impact on heart health.

💡LDL Cholesterol

LDL, or low-density lipoprotein, is often referred to as 'bad cholesterol' because high levels can lead to plaque buildup in arteries. The video script discusses LDL in the context of its relationship with heart disease, suggesting that the focus on lowering LDL levels may be misguided and that it might not be as harmful as previously thought.

💡HDL Cholesterol

HDL, or high-density lipoprotein, is known as 'good cholesterol' because it helps remove LDL cholesterol from the bloodstream, potentially reducing the risk of heart disease. The video emphasizes that the ratio of total cholesterol to HDL, rather than LDL levels alone, may be a better predictor of heart disease risk.

💡Triglycerides

Triglycerides are a type of fat found in the blood, and high levels can increase the risk of heart disease. The video script points out that triglycerides, rather than LDL cholesterol, may be more predictive of heart attack risk, suggesting a reevaluation of their importance in cardiovascular health.

💡Statins

Statins are a class of drugs used to lower cholesterol levels, particularly LDL cholesterol. The video discusses statins in the context of controversy and skepticism regarding their effectiveness and necessity, citing examples of studies that show no cardiovascular benefits despite significant LDL reduction.

💡Vitamin B3 (Niacin)

Vitamin B3, also known as niacin, is aB vitamin that has been used to treat high cholesterol and triglyceride levels. The video contrasts niacin with a statin, suggesting that niacin may be more effective in reducing cholesterol without the associated risks.

💡Clinical Trials

Clinical trials are research studies that test how well new medical treatments work in people. The video script discusses the limitations and potential biases of clinical trials, especially those sponsored by pharmaceutical companies, and their impact on the perception of drug efficacy.

💡Pharmaceutical Industry

The pharmaceutical industry is responsible for the research, development, and marketing of medications. The video raises concerns about the influence of the pharmaceutical industry on medical research, suggesting that financial interests may bias study outcomes and affect the prescription practices of doctors.

💡Vioxx Scandal

The Vioxx scandal refers to the controversy surrounding the painkiller Vioxx, which was withdrawn from the market due to increased risk of heart attacks and strokes. The video uses this as an example of pharmaceutical marketing tactics and the suppression of negative study results, highlighting the need for transparency and independent evaluation of drugs.

💡Stroke

A stroke occurs when blood flow to a part of the brain is interrupted, either by a clot (ischemic stroke) or a ruptured blood vessel (hemorrhagic stroke). The video discusses the relationship between cholesterol levels and stroke risk, presenting evidence that very low cholesterol levels may actually increase the risk of stroke, particularly in hemorrhagic cases.

💡Epidemiological Studies

Epidemiological studies are used to examine patterns, causes, and effects of health outcomes in defined populations. The video cites various epidemiological studies that show no correlation or even an inverse relationship between cholesterol levels and cardiovascular disease mortality, challenging the conventional view on cholesterol's role in heart health.

Highlights

The proportion of people with high cholesterol in the U.S. is decreasing, yet heart disease mortality is increasing.

The Framingham Heart Study has been analyzing cardiovascular diseases and their risk factors since 1948, contributing significantly to heart disease research.

Dr. William Castelli, the former director of the Framingham Heart Study, emphasized that LDL alone cannot predict the risk of coronary artery disease unless it is over 300.

The total cholesterol to HDL ratio and LDL to HDL ratio are better predictors of heart disease than LDL levels alone.

A 30-year study from the Framingham Heart Study found that for every 1 mmol/L decrease in cholesterol, overall mortality increased by 11%, and cardiovascular mortality by 14%.

Research compared LDL cholesterol levels in myocardial infarction patients and found that those with LDL over 105 had a lower mortality rate than those with LDL under 105.

A study by New York pathologists found no correlation between cholesterol levels and the frequency or severity of atherosclerosis.

Dr. Michael DeBakey, a renowned cardiovascular surgeon, confirmed that atherosclerosis has no correlation with blood cholesterol levels.

A study from Fukuoka, Japan, showed that cardiovascular mortality rates were lowest in the group with cholesterol levels between 240 and 259 mg/dL.

Research indicates that as triglyceride levels increase, the frequency and severity of microvascular diseases also increase.

Surprisingly, increased LDL levels were associated with a decrease in the frequency and severity of microvascular diseases.

Pharmaceuticals containing fluoride, including some cholesterol-lowering medications, may have negative health effects.

Fluoride can accumulate in the pineal gland, potentially accelerating calcification and reducing melatonin secretion, which may affect sleep quality.

A study linked fluoride exposure during pregnancy to a decrease in children's IQ, emphasizing the need for caution with fluoride intake.

Research suggests that fluoride may be associated with arterial calcification, which is a risk factor for cardiovascular diseases.

The VIOXX scandal highlighted the importance of transparency in clinical trials and the potential dangers of suppressing negative drug side effects.

Post-VIOXX scandal regulations have improved transparency in clinical trials, but concerns about pharmaceutical company influence remain.

Analysis of clinical trials post-VIOXX scandal showed that many studies sponsored by pharmaceutical companies reported more positive outcomes than independent studies.

The BAYTORIS scandal involved Merck withholding and manipulating data about a cholesterol-lowering drug, raising questions about the integrity of pharmaceutical research.

Some studies suggest that lowering LDL cholesterol too much may increase the risk of stroke, especially in certain populations.

Research indicates that the relationship between LDL cholesterol levels and cardiovascular disease may be more complex than previously thought.

The Framingham Heart Study's calcium score is a superior method for predicting heart attacks, suggesting that other risk factors besides LDL are important.

Current medical guidelines may be overemphasizing the importance of LDL cholesterol levels, potentially leading to unnecessary prescriptions of cholesterol-lowering drugs.

Studies show that low LDL cholesterol levels may be associated with an increased risk of hemorrhagic stroke, especially in younger adults.

The narrative that LDL cholesterol is a 'villain' is outdated and not supported by recent scientific evidence, which calls for a reevaluation of its role in cardiovascular health.