75% Of Heart Attacks Have Normal Cholesterol? Cardiologist Explains.
Summary
TLDRIn 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
🧬 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.
💊 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.
📉 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.
📚 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.
Mindmap
Keywords
💡Heart Attack
💡Cholesterol
💡LDL Cholesterol
💡Atherosclerosis
💡Lipoprotein(a)
💡Lipid-Lowering Therapy
💡Acute Phase Reactants
💡Cholesterol Years
💡Evidence-Based Medicine
💡Cardiologist
💡Statins
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
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