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Cholesterol and Heart Disease

Most people remember the buzz in the late 80s surrounding oat bran and cholesterol. My father, I remember, bought a 25 lb. sack of oat bran and pressed it through his intestines with a passion not often devoted to gray flavorless mush. The fact that my grandfather had died of a heart attack probably kept a specter of dad’s own mortality hanging on the edge of each spoon.

Time has given us more perspective regarding cholesterol. A good lipid profile is still important in protecting against a variety of diseases from hardening of the arteries to dementia, but the show has a new star. C-reactive protein, has taken the spotlight as a better predictor of future heart disease. We don’t need to go into what C-reactive protein actually does for the body. The important thing is that high levels of C-reactive protein demonstrates a person has chronic inflammation. And chronic inflammation is strongly associated with future heart attacks, and a variety of other diseases. Why? That’s the million dollar question that researchers are currently puzzling over.

Many researchers have hypothesized that the reason high cholesterol and high c-reactive protein levels predict heart attacks is that certain persistent bacteria keep themselves safe by wrapping themselves in a layer of cholesterol, which they get from us, their gracious hosts. More cholesterol floating around in the blood translates to more food for dangerous bacteria, which in turn cause more inflammation. Or so the speculation runs. But a person with high cholesterol and no harmful bacteria to eat it won’t have such serious problems. Chlamydia pneumoniae has been a popular suspect for those who think heart disease is caused by bacteria, since many people who had heart attacks also had antibodies to this common but dangerous pathogen. However killing off the C. pnemoniae doesn’t reduce people’s risk of heart attacks by very much, which have caused researchers to rethink things.

It may be that people who were exposed to C. pnemoniae, which is very common, were more likely to be exposed to other pathogens as well, and the true culprits remain undiscovered. (others have speculated that C.pnemoniae may start a disease process which will continue even if the bacterium is killed.) Tuberculosis, which lacks a cell wall, is similar to the type of creature that some think may be breaking us down from the inside out Many common bacteria are capable of throwing off their cell walls. Bacteria without cell walls tend to be slow growing, next to impossible to culture, thrive on cholesterol, and they tend to stick around for a very long time.

This makes discovering if a person is infected with this type of pathogen very difficult. If a doctor wants to know if someone has tuberculosis they will usually test for antibodies to the disease rather trying to culture the disease itself in a petri dish.

When it comes down to it, only about 1% of bacteria can actually be cultured using a standard culture within the amount of time that most labs are willing to spend on a test. So even if someone tells you that they were tested for STDs and are ‘clean’ there is still reason to be skeptical. There’s a lot out there that the guys in lab coats just can’t see.

In any case, looking at cell wall deficient bacteria as an underlying cause of heart disease, helps to explain a lot of data.

While studies attempting to figure out the effect of antibiotics on heart disease remain ambiguous with some studies showing a small positive effect from tetracycline and fluoroquinolones and others showing no benefit at all and a few showing a real but non-significant benefit of azithromycin which decreased quickly after the three month administration stopped, it’s worth noting that killing cell wall deficient bacteria like tuberculosis often requires six months of treatment and with very specific antibiotics. The maximum length of controlled trial was with azithromycin and lasted only 12 weeks. Also, the increase in risk from use of beta-lactam antibiotics is noteworthy since bacteria have been shown to respond to beta-lactam antibiotics by losing their cell walls, thus converting from atemporary but harsh infection to a chronic one. Penicillin class antibiotics are the most well known beta-lactam antibiotics.

Finally, the study cited above notes that analysis is made more difficult because most studies are done by analyzing responses of people who were already sick and then treated for other illnesses. What effect would antibiotics have on otherwise healthy people’s risk of heart attack? That’s what researchers like the ones in the above study are just now beginning to test.

So, despite the fact that a three month course of Azithromycin (which usually kills a wide variety of bacteria in a wide variety of places in your body) only offers short term benefits to healthy people, I’m still curious if a longer treatment with different drugs might bring better results for people who seem to have some kind of chronic, mild infection.

Of course, diet and lifestyle is always the best way to improve our health. But if eating more fibrous veggies, cutting back on meat and getting lots of aerobic exercise isn’t getting your cholesterol levels where you think they should be, the next question becomes; “what’s the best way to minimize side effects from the cholesterol lowering drugs?”

Some people who use statins, currently the most popular drugs for lowering cholesterol, start having muscle pain or diminished energy. Why? Statins prevent the body from producing at least one other noteworthy chemical; coenzyme-Q10 (also called ubiquinone).

Coenzyme-Q10 is used by our bodies to produce energy. There is currently controversy about whether supplementation with coenzyme-Q10 can reduce some of the negative effects of statin drugs. Some studies show wonderful results. Other studies suggest that coenzyme-Q10 delivers no tangible benefits. Conspiracy theories about drug companies altering research, right or wrong, abound. Until this is settled, I’ve talked my dad (who is currently taking low-dose lipitor for cholesterol) into popping a coenzyme-Q10 capsule alongside his pharmaceutical potion. Coenzyme-Q10 in low doses is extremely safe, so it seems like a good idea, at least till this whole mess gets figured out. Also, he keeps his use of lipitor as low as possible, taking only a fraction of a pill at a time.

And in the meantime, it’s worth remembering cholesterol has its benefits as well. The stuff is the raw material for testosterone, vitamin D and other useful hormones. So we don’t want our levels to get TOO low. Heck, castration increases lifespan too. But we all have to draw the line somewhere.
Posted in My Blog on 01/10/2010 01:39 pm

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