For years I’ve wondered why doctors continue to test women for high cholesterol when studies show it has no value in predicting heart attack or stroke. And more to the point, why prescribe cholesterol-lowering drugs to women for heart disease prevention when there’s no proven benefit? Yes, men appear to benefit from cholesterol-lowering, but surprisingly few as it turns out. Wouldn’t it be better—and safer—to simply tell us to have a daily glass of wine? My questions only became magnified this week when I came across the Copenhagen Heart Study (CHS), which has followed healthy people for over 33 years to see who develops cardiovascular problems. As with the Framingham Heart Study, the CHS has generated multiple smaller studies over the years.
I stumbled across the CHS for the first time when its latest findings appeared this month in Annals of Neurology. It focussed on what is probably the most feared consequence of cardiovascular disease—an ischemic stroke. Keep in mind when you read the CHS results that—for men and women—high cholesterol has long been considered a major risk factor for stroke, along with smoking and hypertension.
The CHS found that the blood fats known as triglycerides are more relevant to stroke risk than cholesterol. It concluded that increasing levels of nonfasting triglyceride are predictive of a woman’s high risk for stroke, while increasing cholesterol levels are not. As for men, increasing levels of nonfasting triglyceride are associated with an increased risk of stroke, but cholesterol becomes a risk for stroke only when it’s extremely high (348 mg/dl or higher). These findings were confirmed by a 31-year Norwegian study published last year in the European Journal of Epidemiology.
The standard blood test almost always includes measurement of triglycerides. The new twist introduced by the Danish researchers is nonfasting triglycerides. Their explanation: “except for the first hours of the early morning, most individuals are in the nonfasting state most of the time.” Triglycerides are stored in our fat tissue among other places; the major stimulus for triglyceride production is not fat intake, but carbohydrates and sugar. While earlier research indicates that triglyceride might be a better predictor of stroke, the CHS is the first to separate results by gender. Before we all start to get carried away with triglycerides, keep in mind that there is no proof that lowering someone’s triglycerides also lowers the risk of stroke.
Now for the wine…and here’s another reason to stay with the Danish research. If stroke is the main thing you’d like to avoid (and it is mine), there’s much to be said for drinking. I’ve always been intrigued by the population (observational) studies that show that people who drink alcohol have a lower risk of stroke than people who don’t. Denmark became an unintentional experiment in 1976 when this nation of liquor and beer drinkers turned rather suddenly and enthusiastically to wine. The change was due to the opening of the European market.
Here’s what the researchers found after following 13,000 men and women, age 30-70 years, for the first 12 years after wine became instantly more accessible. “Low to moderate intake of wine is associated with lower mortality from cardiovascular and cerebrovascular disease [stroke] and other causes. Similar intake of spirits implied an increased risk, while beer drinking did not affect mortality.”
This off-shoot of the CHS is interesting from several perspectives. It’s the first to study the health effects of wine drinking in a non-Mediterranean country; it did not show that other forms of alcohol had similar health benefits to wine, as all other studies have since found; and it had a broader definition of “low to moderate drinking” than U.S researchers typically use.
Low wine consumption was defined as 1 to 3 glasses of wine daily, moderate was 3 to 5 glasses of wine daily. There was a 49% decrease in total mortality among the moderate drinkers and a 30% decrease among those with low consumption, compared with people who never drank wine. As for Denmark’s increase in wine consumption during the 12-year-study period, it went from 17% of total alcohol consumption in 1975 to 30% in 1992. The CHS was financed by the Danish National Board of Health.
It’s likely that the medical profession will soon let go of the idea that cholesterol is an important risk factor. And the unwarranted enthusiasm for statins will dim slowly as we get to the end of this year when the patent for Lipitor runs out. This $10 billion-a-year cholesterol-lowering statin drug, which is excellent at lowering cholesterol but modest (at best) at lowering the chance of stroke or heart attack, will be the last of the statin drugs to lose exclusive rights.
Raise a glass of wine to that thought.
For more information
-Not convinced that women with high cholesterol but no heart disease will not benefit from cholesterol-lowering drugs? Read this and be sure to click into the link to the 2004 JAMA study referenced within the article. As for the effectiveness of these drugs in men, click here And lastly click here to see the effectiveness of cholesterol-lowering drugs for people who already have heart disease.
-Triglycerides are more relevant to heart disease than cholesterol, according to extensive research dating back to the 1950s. For more on this topic, see Gary Taubes’s book, Good Calories, Bad Calories—Challenging the conventional wisdom on diet, weight control, and disease.” click here
-Here’s the 1995 Copenhagen Heart Study results about the 12-year period following the broad availability of wine. click here
-Need a more recent wrap-up of all the best wine-heart disease studies? Read this analysis of 21 such studies that confirmed the finding that light- to moderate-drinking is better for the heart than not drinking. As for stroke mortality, even just one drink a day will lower your chances. And by the way, binge drinking is a major no no. click here
-Too many white people in these drinking and stroke prevention studies? Here’s one with the same finding in favor of moderate drinking but the participants are broadly representative of the U.S. population (be sure to scroll way down).
Maryann Napoli, Center for Medical Consumers(c)
Center for Medical Consumers 