Questioning Cholesterol (02:21)

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Aaron Holm has familial hypercholesterolemia; doctors say he is at high risk of heart attack. He has resisted taking medication due to possible negative long term effects.

Framingham Heart Study (02:47)

Beginning in the 1940s, 5,000 volunteers have participated in a longitudinal study that identified smoking, high blood pressure, obesity, and arterial plaque as heart disease factors. The Heart Attack Grill in Las Vegas serves cholesterol laden meals.

Dietary Cholesterol Risk Factor (02:24)

20th century studies comparing European, Asian and North American diets 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 (02:35)

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 (02:11)

Worldwide, approximately one billion people take the drugs to lower LDL cholesterol levels. Now 40, Holm has avoided a heart attack and doesn't want to take medication—but few doctors are open to alternative treatment.

Statin Benefits (01:46)

The most widely prescribed drugs inhibit liver cholesterol production. Dr. Beth Abramson explains that cholesterol isn't the only factor, but medication does lower risk of death among heart disease patients.

Statin Debate (04:19)

Dr. Barbara Roberts argues the drugs are over prescribed, don't prevent 60% to 80% of heart attacks, cause more 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 (01:57)

50% of heart attack victims have normal cholesterol levels. Cardiologist Paul Ridker found an inflammation marker, C-reactive protein, which predicted heart attack risk.

Inflammation Lowering Study (02:57)

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 Heart Gene (03:28)

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 (02:18)

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 drug companies are having trouble mass producing a treatment.

Bacteria Risk Factor (03:55)

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 (03:27)

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 (03:12)

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 (02:16)

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

Credits: The Cholesterol Question (01:12)

Credits: The Cholesterol Question