Cholesterol levels are a lousy predictor of heart disease

Fish oils, along with fruits and veggies, strengthen your heart.

There are two ways to deal with cholesterol. The first is to accept the premise that high cholesterol is a very bad thing that puts you at serious risk for heart disease. That's the conventional approach.

The second way is to question whether we need to be all that concerned about cholesterol, one of the most misunderstood molecules on the planet. It's been so successfully demonized that lowering it is a multibillion dollar business, with more than $20 billion a year generated just by the two top cholesterol-lowering medications, Zocor and Lipitor.

TLC for Your Heart
But let's face it: You don't really care what your cholesterol level is. What you really care about is your risk for heart disease. And you've come to believe they're essentially the same thing. But they're not. The truth is that cholesterol levels are a lousy predictor of heart disease. A large percentage of people with normal cholesterol have cardiovascular disease, and half of people who have heart attacks have "normal" cholesterol.

Consider a classic study conducted in France over a four-year period and published in Circulation. The study-called the Lyon Diet Heart Study-looked at 605 patients who had already had a heart attack and who had classic risk factors, including high cholesterol and being a smoker. Roughly half were directed to eat a diet lower in fat and cholesterol; the other half were given instructions on following the Mediterranean diet, high in olive oil, vegetables, fruits, and so on. Neither group was given a statin drug. Those following the Mediterranean diet had a 72 percent decrease in coronary events and a 56 percent decrease in overall mortality. But that's not even the best part-their cholesterol levels hardly budged.

Other studies have shown similar results. For example, the Nurses Health Study-one of the longest-running and most respected studies on diet and health outcomes-found that five basic behaviors reduce the risk of heart disease by an astonishing 82 percent. The five behaviors? Maintaining a healthy weight, exercising regularly, eating a diet rich in omega-3 fats (particularly from fish) and fruits and vegetables, drinking alcohol only moderately, and not smoking.

Not All LDL Cholesterol Is Created Equal
There are several subtypes of both good (HDL) and bad (LDL) cholesterol. The subtypes of LDL are far more meaningful than the overall LDL number. Some LDL molecules are large particles-these are fairly harmless. The small ones are not. So it's no longer enough to know that your "bad" cholesterol has gone up. More cutting-edge physicians are testing for subtypes of LDL.