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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