The following unpublished text was submitted to the Straits Times:
I refer to Dr Lim’s article – Dietary fads: truth or fallacy and generally
agrees with his dietary advise for heart health.
However, cholesterol levels are just one piece of the mystery of reducing
heart diseases. As a matter of fact, more than 50% of heart attacks occur
in those with normal cholesterol levels. In fact, people with too low
cholesterol has fewer circulating lymphocytes and other immune cells,
which place them at risk of infection and this in turn cause further
injury to blood vessel walls ie. endothelial dysfunction (blood vessel walls).
Atherogenesis begins in the injury to the endothelial cells of the
arteries. Modern research points out that atherogenesis is no longer
considered a disorder of cholesterol or lipid accumulation but rather a
disease characterised by dysfunction in the endothelial cells, oxidised
LDL (not just LDL) and low HDL (‘good’ cholesterol) which fuels the
inflammatory process. Among other factors in the progression of heart
diseases are oxidative stress, tissue damage as a result of deficiency of
oxygenated blood, capillary wall integrity, vitamin deficiency and
emotional stress. The inflammatory process is what triggers thrombosis,
unstable plaque and finally heart rhythm disturbances.
Therefore the total cholesterol to HDL ratio or LDL to HDL ratio are
considered cardiac risk factor ratios rather than looking at LDL
cholesterol alone in determining the use of pharmaeutical agents.
The inflammatory process is also triggered by the cross talk between the
hypothalamic -pituitary-adrenal axis, the sympathetic nervous system and
inflammatory mediators. In other words, oxidised LDL and other risk
factors can be affected and increased with stress including work stress
and emotional stress such as constant anger, anxiety and worry.
Judging by the high stress lifestyle of most people in Singapore, it is
more appropriate to look at heart diseases from a holistic perspective and
not just to treat or lower LDL cholesterol alone.