Can Lowering Cholesterol Reduce the Risk of Heart Disease? Are Statins Worth Taking?
Dr. Cai Kaizhou, president of the Taiwan Natural Orthopedics Institute and an attending physician in the Orthopedics Department at National Taiwan University Hospital, recently addressed what he calls the “cholesterol myth” on NTDTV’s Health 1+1 program. He shed light on what he believes is the real key to cardiovascular health.
According to Dr. Cai, cholesterol plays a vital role in the body’s repair processes, yet it has been unfairly vilified over the past 50 years. Much of the public fear around cholesterol comes from its assumed link to heart disease. However, Dr. Cai emphasizes that cholesterol is neither the only nor the primary cause of heart disease. Simply lowering cholesterol does not automatically translate to a lower incidence of cardiovascular issues.
Supporting this perspective, a 2019 study published in Scientific Reports tracked 12.8 million Koreans over a 10-year period. The findings revealed that total cholesterol levels below 200 mg/dL were associated with higher all-cause mortality. The relationship between cholesterol levels and mortality followed a U-shaped curve: both very low and very high cholesterol levels were linked to increased risk, but the rise in mortality was more pronounced at the lower end. This trend held true across all age groups.
Challenging the Cholesterol Narrative
Dr. Cai Kaizhou pointed out that recent findings challenge the widely held belief that lowering cholesterol reduces mortality. Since individual cholesterol levels vary, he cautioned against the blanket approach of aggressively lowering cholesterol. Instead, he urged people to pay closer attention to more critical contributors to heart disease—particularly vascular inflammation.
Cholesterol: A Vital Nutrient
Dr. Cai emphasized that cholesterol is not inherently harmful but is, in fact, an essential nutrient. The majority of the body’s cholesterol is produced by the liver and distributed throughout the body, with the exception of the brain, which independently synthesizes cholesterol and contains about 25% of the body’s total supply.
Cholesterol plays a key role in the structure and function of cell membranes and is integral to signal transmission, neural communication, and cellular signaling pathways. It also contributes to the synthesis of vitamin D, sex hormones, and bile salts—substances that aid in the absorption of fat-soluble vitamins A, D, E, and K.
Clinical Insights: Side Effects of Cholesterol-Lowering Medications
Drawing from his clinical experience, Dr. Cai shared numerous cases in which patients developed serious side effects after taking statins, the most common cholesterol-lowering drugs. These cases led him to question whether the medical community should place such strong emphasis on reducing cholesterol levels.
He highlighted the following recurring issues:
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Muscle Weakness and Instability
One of the most common side effects he observed was muscle frailty. Patients reported being unable to stand on tiptoe, experiencing foot pain from plantar fasciitis, walking with difficulty, and even falling frequently. In one instance, a man in his 50s began having balance issues and frequent falls just weeks after starting statins. -
Joint Pain and Muscle Inflammation
Many patients complained of knee pain, limited mobility, and difficulty exercising. Dr. Cai also observed cases involving muscle and bone inflammation, osteoporosis, sarcopenia (loss of muscle mass), and even memory problems—all potentially linked to cholesterol-lowering drugs.
Reevaluating Cholesterol-Lowering Drugs: Benefits and Risks
Dr. Cai Kaizhou emphasizes that while cholesterol-lowering medications can be effective, their potential side effects must not be overlooked. He urges caution when using such drugs and advises against taking them indefinitely without proper medical guidance.
Statins, the most commonly prescribed cholesterol-lowering drugs, work by inhibiting cholesterol synthesis in the liver. However, they also suppress the production of important compounds like coenzyme Q10, which is essential for mitochondrial function. This disruption can reduce the energy supply to cells, leading to symptoms such as muscle pain, fatigue, and weakness.
In addition to muscle-related issues, Dr. Cai warns that statins can also cause liver damage, cognitive decline, and male sexual dysfunction. Therefore, the decision to use these medications should be based on individual health needs, with a full understanding of both the benefits and risks.
A Broader View of Heart Health
Many people mistakenly assume that lowering cholesterol is universally beneficial. Dr. Cai stresses that cholesterol levels vary greatly between individuals and are naturally regulated by the liver. As such, medication may not always be necessary or effective.
He highlights the role of inflammation as a more critical factor in cardiovascular disease. Inflammatory responses in the body can trigger the liver to produce more ultra-low-density lipoprotein (LDL) cholesterol. Identifying and addressing the root causes of inflammation—rather than focusing solely on cholesterol—may be more effective in preventing heart disease and stroke.
According to Dr. Cai, the C-reactive protein (CRP) level is a key marker of inflammation. Ideally, the CRP value should be under 0.1 mg/L—and preferably under 0.02 mg/L. When inflammation is minimal, the risk of cardiovascular events significantly decreases.
Major Contributors to Vascular Inflammation
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Sugar and refined starches are among the leading culprits in damaging endothelial cells, which line blood vessels.
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Heavy metal pollution also raises the risk of cardiovascular disease and should be minimized wherever possible.
Key Health Indicators to Monitor
To maintain cardiovascular health, Dr. Cai recommends regular blood tests and monitoring the following key indicators:
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Triglycerides: Should be below 150 mg/dL. This is often achievable through a low-carb diet.
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HDL (High-Density Lipoprotein) Cholesterol: Known as “good cholesterol,” optimal levels are over 60 mg/dL. Omega-3-rich fish oil can help raise HDL.
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Waist Circumference: A better predictor of health than BMI—ideally, it should be less than half of your height.
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Dense LDL Cholesterol: Higher concentrations of small, dense LDL particles are more harmful. Aim for levels below 50 mg/dL, and ideally under 35.
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Homocysteine: Elevated levels increase the risk of dementia, heart disease, and stroke. Keep it below 8 µmol/L.
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Vitamin D: Supports heart health. Levels should be above 80 ng/mL during treatment and consistently over 50 ng/mL for maintenance.
Lifestyle Over Medication
Dr. Cai concludes that simply taking medication without addressing lifestyle factors is unlikely to lead to real health improvements. In fact, over-reliance on drugs may reduce quality of life. Instead, he advocates for:
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A low-carbohydrate diet
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Intermittent fasting
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Eating only when hungry, not out of habit
By focusing on the root causes of disease—like inflammation and diet—rather than just managing symptoms with medication, Dr. Cai believes people can achieve better long-term health outcomes.