My Cholesterol Is Too Low for the Heart Attack Risk Calculator!

I tried to use the Nation­al Cho­les­terol Edu­ca­tion Program’s Risk Assess­ment Tool for Esti­mat­ing Your 10-Year Risk of Hav­ing a Heart Attack. I entered my data on the form, and I got back an error mes­sage, telling me to enter a total cho­les­terol val­ue of 130 or greater! Accord­ing to the cal­cu­la­tor, even if my cho­les­terol went up to 130 mg/dL, I’d still have less than a 1% chance of hav­ing a heart attack with­in the next 10 years.

(Note: here’s a live ver­sion of the tool, which does not give an error mes­sage:

If I ran the Nation­al Cho­les­terol Edu­ca­tion Pro­gram, I’d real­ly edu­cate peo­ple about cho­les­terol. I’d tell them the sim­ple truth: that when you keep your total cho­les­terol at less than 150 mg/dL, coro­nary artery dis­ease ceas­es to exist. Near­ly every­one can eas­i­ly achieve that goal by eat­ing a low-fat (<10% of calo­ries), plant-based diet.

Instead, the NCEP tells peo­ple that a total cho­les­terol lev­el of  up to 200 mg/dL is “desir­able.” Lots of peo­ple with this “desir­able” cho­les­terol lev­el are dying of heart attacks, which is why many peo­ple, includ­ing many doc­tors, are con­fused.Pho­to by win­nifredx­oxo

5 thoughts on “My Cholesterol Is Too Low for the Heart Attack Risk Calculator!”

  1. I am curi­ous what you say to those who respond that their high cho­les­terol is genet­ic? That they’ve tried a low-fat plant-based diet to no avail.

    I per­son­al­ly feel the role of genes is over­stat­ed, but I was won­der­ing how you deal with the issue.

  2. In biol­o­gy, there is noth­ing that nev­er hap­pens. Yes, there are some hered­i­tary caus­es of high cho­les­terol. How­ev­er, they are exceed­ing­ly rare.

    Heart dis­ease can become prac­ti­cal­ly nonex­is­tent with­in a pop­u­la­tion if it shifts to a low-fat, plant-based diet. Some coun­ties in Chi­na with a pop­u­la­tion of a few hun­dred thou­sand had zero deaths in any­one under 65 over the course of two or three years.

    The genet­ic dis­or­der called famil­ial hyper­c­ho­les­terolemia is actu­al­ly rare. About 1 in 500 peo­ple have one copy of the gene, and they are prone to hav­ing heart attacks in their 30s and 40s on a stan­dard Amer­i­can diet. About 1 per­son in a mil­lion has two copies of the defec­tive gene, and they can have severe heart dis­ease in child­hood.

    Peo­ple who have one copy of the bad gene are usu­al­ly treat­ed with diet mod­i­fi­ca­tions, along with drugs such as statins and bile acid seques­trants. The unlucky peo­ple with two copies of the bad gene might need a liv­er trans­plant.

    I want to empha­size how rare these prob­lems are. Most of the peo­ple who claim that they’ve tried a low-fat diet to no avail have been try­ing to fol­low the Amer­i­can Heart Association’s advice to eat a diet that is 30% by calo­rie, not the 10% by calo­rie that Dr. Essel­styn sug­gests. As Dr. Essel­styn says, when it comes to low­er­ing cho­les­terol, mod­er­a­tion kills.

    Also, peo­ple tend to over­es­ti­mate the amount of good food that they eat and under­es­ti­mate the amount of bad food that they eat. So when peo­ple tell me that they’ve tried a healthy diet to no avail, I take what they say with a huge grain of salt, espe­cial­ly if they are fat­ter than I am.

  3. So, if you’d say any­thing it might be to urge them to go low­er in fat? It real­ly would be telling for some­one who swears by high-cho­les­terol genes to go low­er than 10% fat. To just try it.

  4. I’d tell them the sim­ple truth: that when you keep your total cho­les­terol at less than 150 mg/dL, coro­nary artery dis­ease ceas­es to exist.

    I am inter­est­ed where this truth comes from? If you could point to this infor­ma­tion I would be grate­ful.

  5. Hi Bix:
    If peo­ple have genes for high cho­les­terol lev­els, then it’s par­tic­u­lar­ly impor­tant for them to eat a low-fat diet. Of course, the peo­ple who swear that their high cho­les­terol is genet­ic don’t want to hear that. They want to believe that their high cho­les­terol is not their fault. They don’t want to try a low-fat diet, because they are afraid that they’ll find out that they can con­trol their cho­les­terol by giv­ing up the foods they like.

    Anony­mous, sev­er­al kinds of stud­ies have point­ed to the fact that coro­nary artery dis­ease ceas­es to exist when peo­ple main­tain their total cho­les­terol at 150 mg/dL or low­er. They include cross-sec­tion­al pop­u­la­tion stud­ies (notably the Chi­na Study), lon­gi­tu­di­nal pop­u­la­tion stud­ies (espe­cial­ly the Fram­ing­ham study but also the stud­ies on heart attack rates dur­ing food rationing in WWII), and inter­ven­tion­al stud­ies (i.e., the work of Dean Ornish and Cald­well Essel­styn). You can find a lot more infor­ma­tion here:

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