Cholesterol Question (01:58)

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Heart attack strikes every 34 seconds in North America. Cholesterol has traditionally been the culprit, but 50% of victims have normal cholesterol levels. This film will examine its role in heart disease.

Framingham Heart Study (03:40)

Aaron Holm has hypercholesterolemia; doctors say he's at high risk of heart attack. A longitudinal study of heart disease factors led to the discovery of cholesterol in arterial plaque.

Dietary Cholesterol Risk Factor (03:06)

Studies in the 20th century led doctors to believe high cholesterol comes from a high fat diet. A more recent study found no correlation between egg consumption and arterial cholesterol levels.

War on Fat (02:29)

Saturated fat raises LDL, but also increases HDL, the "good" cholesterol. Low-fat food pyramid recommendations increased processed carbohydrate consumption and led to obesity, diabetes, and high blood pressure. Many heart attack victims have normal LDL levels.

Statin Industry (03:02)

The widely prescribed drugs lower LDL cholesterol levels. Holm avoided a heart attack and doesn't want to take medication. Dr. Beth Abramson explains that cholesterol isn't the only factor, but statins do lower risk of death among heart disease patients.

Statin Debate (03:56)

Statins reduce heart attack risk in heart disease patients. Dr. Barbara Roberts argues they are over prescribed, more likely to cause side effects in women, and that cholesterol is only a risk factor until middle age. Abramson argues that side effects are minor and reversible.

Inflammation Risk Factor (02:41)

Recent American Heart Association guidelines increased statin prescriptions; 50% of heart attack victims have normal cholesterol levels. Cardiologist Paul Ridker found an inflammation marker, C-reactive protein, that predicted heart attack risk.

Inflammation Lowering Study (02:20)

Statins lower CRP, and thus lower risk in patients with low cholesterol but high inflammation levels. Ridker is testing an anti-inflammatory drug used to treat arthritis on heart attack patients.

Miracle Gene (03:39)

Dr. Cesare Sirtori screened a community in Limone, Italy, with high LDL and low HDL cholesterol. A genetic mutation in their HDL prevented them from developing heart disease.

HDL Study (02:12)

Sirtori theorized that a genetic mutation increased HDL efficiency among Limone residents. Clinical trials with a synthetic version reversed plaque buildup in heart disease patients, but companies are having trouble mass producing a treatment.

Bacteria Risk Factor (03:19)

Dr. Stanley Hazen found a compound, TMAO, in heart attack victims that correlated with cardiac risk. It originated as carnitine, a gut bacteria byproduct from red meat that appears in the bloodstream and enhances heart disease. He recommends reducing red meat consumption.

Heart Disease Decision (03:25)

Holm doesn't eat red meat, and is likely safe from TMAO, but his cholesterol levels are high. Abramson doesn't find plaque, but Holm's arteries are thickening. He agrees to go on a statin to lower his risk of heart attack.

Diabetes Risk Factor (03:19)

Dr. Guillaume Pare's team studies how genetic variations affect our response to heart disease risk factors. They are looking for DNA mutations increasing risk among 5,500 diabetic patients; the human genome poses a big data challenge.

Exercise Risk Factor (02:11)

Middle aged and older people who exercise daily rarely suffer heart attacks or strokes. Doctors are trying to set a good example for patients by increasing activity and instilling healthy habits in younger people. Cholesterol remains a risk factor, among others.

Credits: The Cholesterol Question (01:06)

Credits: The Cholesterol Question