If you are like 1 in 10 Canadians that have been prescribed cholesterol-lowering medications known as statins to lower your risk of developing heart disease, there might be some additional information worth reviewing before jumping into statin therapy.
It’s no secret that statins are overprescribed in North America. Healthcare providers have been lobbied to increase the use of statins in their practice despite limited evidence for their efficacy in preventing morbidity and mortality related to heart attack and stroke.
Statin drugs come with a significant list of negative side effects, which should each be carefully considered before starting therapy. If you have a loved one that has been taking a statin medication (as I did) – this article may help your family navigate this confusing landscape. Cardiovascular health is especially important for male sexual health, including erectile dysfunction, which is a growing issue globally.
DISCLAIMER
The following information in this article, along with all information on LoLoHealthCo.com is for educational purposes only. It is not meant to replace medical advice. Please use this information to work collaboratively with your healthcare provider to ensure you are getting personalized high-quality medical advice.
The cholesterol hypothesis of heart disease is indeed, one hypothesis. The evidence to support this theory has been grossly overstated in the literature, which has been largely funded by big pharmaceutical companies making statins. Current heart health recommendations were established back in the 1950s when the American Heart Association received an enormous donation from the canola oil industry to convince people to switch from eating natural fat like butter to industrially processed oils like canola and cottonseed. The canola industry made billions of dollars from their recommendations, supporting the low-fat, low-cholesterol diet to improve heart health theory. As you will see, natural fat and cholesterol are essential for good heart health. Outdated recommendations to increase inflammatory vegetable oils, avoid cholesterol and eat more whole grains have propelled us into the epidemic of obesity, diabetes and heart disease we see today. Instead of insisting that the status quo will eventually start to work if people would just “stick to their diets better,” we will show you the best non-pharmacological ways to successfully decrease your risk for heart disease.
Statin drugs are a multi-billion dollar industry. This gives big pharmaceutical companies huge amounts of money to run biased clinical trials that they’ve used to convince medical boards of their efficacy. Trust me when I say that corporate pharmaceutical companies don’t have your health at the top of their priority list and we should not be blindly trusting their advice. When independent 3rd party review boards have gone through the research on heart disease and statins, a completely different story is told. So the deceptive saga of how total cholesterol causes heart disease continues, but I am hopeful that these recommendations will be changing soon.
For more information how why fat and cholesterol are important for our health, see our Nutrition Guide.
FAT + CHOLESTEROL ARE IMPORTANT FOR HEALTH
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High-quality fat is essential for good health. Fat has two important roles in the body, both as a structural component in our brain, nervous system and other organs as well as a dense energy source to help fuel our cells. Healthy fats are critical for good brain health and were the key nutrient in our ancestors’ diet that allowed our brains to rapidly develop during our evolution. Our brain is structurally about 60% fat and 25% cholesterol. Cholesterol wraps around our neurons protecting them and promoting cognitive function. This is why breast milk is composed of 25% saturated fat and 4% cholesterol to support the growth of the developing nervous system, as these are the two most important nutrients for a growing brain. Having more cholesterol in the brain has shown to be protective against developing neurological disorders like dementia and MS. Cholesterol is a critical component of cell membranes and is used to make almost every hormone in the body including vitamin D, which is essential for immune health. Cholesterol is used to make thyroid hormones and adrenal hormones, essential in sleep, energy production and metabolism. Cholesterol is used to make sex hormones like testosterone (T). Low T levels are linked to low libido, erectile dysfunction, cardiovascular disease (CVD) and dementia. LDL cholesterol-carrying proteins are the main transport mechanism for cholesterol to reach the testicles. So it’s no surprise that the most common side effects of statins are memory loss, nerve pain, muscle pain, hormone imbalances, insulin resistance, low sex drive and erectile dysfunction. Pretty horrifying to think that over 3 million Canadians are currently taking medication to lower this essential nutrient and drug companies are looking to expand their recommendations to include children?.
Providers continue to over-prescribe these medications based on LDL and total cholesterol numbers, which have proven to be a poor diagnostic measure for cardiovascular risk. If you are curious about your risk, continue reading below to find out how to collaboratively work with your healthcare team to get a more accurate diagnosis.
CHOLESTEROL, LDL, HDL & TRIGLYCERIDES
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Let’s start by clarifying some information about “good” and “bad” cholesterol. As you’ve read above, all forms of cholesterol are essential in the body and have equally important roles to play in keeping us healthy. The problem is not with how much or how little LDL or HDL we have, rather what is happening to these particles to dysregulate their function in the body resulting in the mismanagement of their important contents. An excellent example of how important cholesterol is for health is the fact that the liver will make even more cholesterol if it is avoided in the diet in order to maintain stable levels of serum cholesterol in the blood. The body wouldn’t upregulate the production of a nutrient if it wasn’t needed – this would be a huge waste of energy and resources. This is why restricting dietary cholesterol has a relatively insignificant effect on serum (blood) cholesterol levels. Therefore, low-cholesterol dietary recommendations and cholesterol absorption inhibitory drugs generally do not have a significant effect on lowering blood cholesterol levels.
Problems arise in the body when our lipid cycle becomes dysregulated and cholesterol proteins hang out in circulation for too long – this changes their particle size and density, leaving them prone to oxidation. Oxidation is what happens when an apple turns brown or metal rusts. Oxidized LDL particles are what actually increase our risk for heart disease, not your total LDL which is currently being used in practice. There are several factors that can influence our cholesterol particle sizes and their risk for oxidation. Finding out these values is imperative for determining and diagnosing risk for heart disease and before starting pharmacotherapy.
The development of heart disease is largely influenced by these four factors aside from family history: inflammation, oxidation, stress and blood sugar/insulin levels. You get these four values right and our risk is significantly reduced for developing heart disease. Even better, if you have been previously at risk, you can help reverse some of these factors to improve your current cardiovascular health. Excessive Inflammation is the common denominator that puts our bodies at risk for oxidative damage that can cause cancer, heart attacks, strokes, autoimmune diseases, neurodegenerative diseases, organ dysfunction, and accelerated ageing. Oxidative stress is a natural byproduct of metabolism in the body, which has a built-in cleaning mechanism to neutralize and remove these damaging particles. However, there is a limit to what it can accomplish. When these oxidative particles accumulate and surpass the threshold of what our bodies can clean up, the balance of antioxidants being able to extinguish the oxidants in our body is thrown off, leaving our tissues and blood particles vulnerable to damage. This is where part of the problem comes in with our LDL carrier proteins.
Cholesterol Carrying Proteins
Normally our cholesterol-carrying proteins travel throughout the body delivering things like fats, phospholipids, cholesterol and other important nutrients to different cells throughout the body. For example, LDL carrier proteins deliver triglycerides to heart muscle tissue, which uses them directly for energy. It also delivers antioxidants to these sites to help neutralize free radicals in these highly-metabolic areas. LDL proteins also deliver cholesterol to our thyroid gland to make T3 and T4 thyroid hormones. LDL is also important for immune function, it delivers antioxidants to areas of the body that are trying to fight infections. So when our cells need more of these nutrients, the liver will make and release more of them. Lowering the function of these hard-working proteins inhibits all of these important functions.
As LDL proteins travel around the body delivering their nutrient packages, they start to shrink; the larger fluffy LDL (type A) becomes a smaller, less dense LDL (type B) which, is now more vulnerable to oxidation. In a healthy lipid cycle, this small LDL-carrying protein travels back to the liver where it will get broken down and recycled into another protein molecule. In an unhealthy lipid cycle where someone is more at risk for cardiovascular events, this smaller LDL particle stays in circulation, remaining in the vessels where it is exposed to serum oxidation. This LDL particle is even more vulnerable in someone who is stressed, has chronic inflammation or who has let their antioxidant to oxidant ratio balance become too low, as these scavenging particles are more likely to cause damage LDL when there are more around. When inflammation and small LDL particles (type B) are high in the blood, you have an increased risk for heart disease. These radical particles start running into small LDL proteins, causing them to drop their contents like fat and cholesterol into the blood where they can cause issues. This triggers an inflammatory response that recruits macrophages to clean up this spill, which then get incorporated into the endothelial cell walls, becoming a plaque – this is known as atherosclerosis. Taking a statin medication lowers the liver’s production of new large fluffy LDL particles (type A), potentially leaving a higher percentage of older small LDL particles in circulation, which can increase the risk for oxidation and plaque formation.
HDL-carrying proteins work in the same way the LDL ones do. Providers are still using the terminology “good” for HDL cholesterol, but HDL can become vulnerable to oxidation as well by getting stuck in circulation, becoming small and less dense. A dysfunctional lipid cycle is going to cause issues for all of our carrying proteins, no matter how “good” the jobs are that they perform. HDL-carrying proteins have been known as “good” cholesterol because of their ability to clean up extra nutrients like cholesterol around the body and bring it back to the liver for recycling. However, this doesn’t make its job any more important than the LDL particles leaving the liver. So with this explanation, you can see how simply measuring your LDL or total cholesterol in your doctor’s office really tells you nothing about your risk for developing cardiovascular disease. Furthermore, it should clearly demonstrate why cholesterol-lowering medications that prevent the liver from making more carrying proteins, also doesn’t lower your risk for cardiovascular disease. These new carrying proteins are not the problem, its what is happening to them in circulation and the dysregulation of their cycle that causes the formation of atherosclerosis.
Additionally, the pathway that statins use to block the enzyme that makes cholesterol via the mevalonate pathway in the liver makes a host of other important nutrients for the body whose production is halted along with cholesterol in this process. One specific nutrient is coenzyme Q10 (CoQ10), which is essential for energy production in the mitochondria of muscle cells. CoQ10 is needed in especially high concentrations in highly active muscles like the heart where the production of more ATP (energy for your cells) is needed. When muscles are deprived of CoQ10, their mitochondrial cells can’t make enough energy for them, causing them to break down, resulting in one of the most common side effects of statin drugs – muscle pain. This is why it is essential for anyone taking a statin medication to also be supplementing with CoQ10 to help prevent the breakdown of these important muscle cells. Ironic that the drug prescribed to supposedly protect the heart can actually physically harm it.
If your healthcare provider has prescribed a medication for you, make sure they can provide the following information:
- What are we going to be doing to address the underlying cause of my condition while I am taking this medication?
- What are the studies showing the effectiveness of this drug?
- What is the NNT and NNH of this drug?
- What are the side effects of this medication + how will you be monitoring them while I am taking it?
- Are there any natural alternatives to this drug that might be helpful with fewer side effects?
-If they do not have this information, ask them to find it for you
EFFECTIVENESS OF STATINS
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Now that we have talked about the safety and side effects of drugs, let’s talk about the safety of cholesterol-lowering drugs. By now, you’ve seen the important role that cholesterol plays in maintaining good health for your entire body. So the question remains, does lowering my cholesterol levels decrease my risk for developing cardiovascular events?
To answer this we can look at those numbers we talked about above known as the NNT and NNH of the drug. These values are the number needed to treat and the number needed to harm. Meaning, how many people need to take this medication in order for it to treat one person or harm one person? Obviously, a safe and effective drug will have a low NNT and a high NNH. The NNT for statins is 104, meaning that 104 people would have to take a statin every day for 5 years in order to see one person benefit from that drug. That means that this population of 104 people would need to swallow 189,800 pills in order to see one person benefit from it ($43,680 in pills for the manufacturer). The absolute risk reduction of taking a statin was also found to reduce your risk of a cardiovascular event by 1.5%. Meaning that a man taking a statin is 1.5% less likely to suffer from a heart attack than a man not taking a statin. Additionally, over half of the people hospitalized for heart attacks have normal cholesterol levels, which would be impossible if heart attacks were caused by high cholesterol alone. So you might be thinking that maybe these minuscule improvements from a statin might be worth their billion-dollar price tag if they were actually able to prevent one event in 104 people if the medication was relatively safe to take – this is where the NNH comes in
The NNH for statins is 21, meaning that only 21 people need to take a statin before side effects start to appear. New-onset diabetes shows up in 1 in every 200 people taking a statin. Therefore, statins have a high NNT and low NNH, which is not a safe or effective drug. Not ideal when these medications are typically prescribed to older adults and cause side effects including loss of memory, hormonal dysfunction, sexual dysfunction, impaired immune system and increases in insulin resistance. Additionally, statins have only been shown to help reduce cardiovascular events in high-risk middle-aged men with a previous cardiac history (secondary prevention) and have shown no efficacy as a primary prevention drug in people who simply have abnormal blood work.
The fact that statins lower cardiovascular risk as a secondary prevention drug in men aged 45-69 actually has nothing to do with lower cholesterol. This benefit comes from their mild anti-inflammatory effects, as they inhibit nuclear factor kappa B (NF-kB), an inflammatory particle that is depressed via the same mevalonate pathway mentioned with CoQ10. NF-kB is an important pro-inflammatory marker that activates the immune system. Lowering NF-kB may be beneficial for short-term inflammation, but the risks of having this pathway lowered long-term are unknown. We do know that some bacteria like E. Coli and salmonella actually cause infections by suppressing NF-kB, lowering our immune response to an infection. Additionally, increased risk for infection is another side effect seen with statin therapy. Further, statins mildly thin the blood, making it less likely for blood clots to form, slightly reducing the risk for thrombotic heart attacks or strokes. Although statins may provide some benefit to this high-risk group, the 1.5% benefit doesn’t seem like a good risk-to-benefit ratio I’d be willing to take with my family members. Since this benefit has only been demonstrated in middle-aged men with a previous cardiac history, statins should nearly never be prescribed for women, children, or the elderly – as there has been zero evidence to prove their efficacy in these groups.
Thankfully, we already know of much better and safer ways to decrease inflammation throughout the body and improve cardiovascular blood markers. One study found that the Mediterranean diet had an NNT of 61 for preventing cardiovascular events and death with an NNH of zero! These numbers are far more impressive than statin therapy and yet statins are still being prescribed to anyone with elevated LDL particle numbers. Statins have been shown to increase the risk for several types of cancer, dementia, and diabetes.
TESTS YOU CAN ASK YOUR HEALTHCARE PROVIDER FOR
Ask your provider for some of these tests in order to get a more accurate picture of your cardiac health.
- Triglyceride: HDL ratio – is one of the best and underrated ways of measuring cardiovascular risk. This can be calculated from a standard lipid panel blood test and has been shown to be a significantly better measurement for predicting heart disease. Calculate this by dividing your Triglyceride number by your HDL number – you want to see this ratio being less than 2.0, ideally closer to 1.0 or lower is best. A good TRI number is typically less than 2.21 and HDL greater than 1.9. For example, in my most recent blood work my TRI was 0.68 and HDL was 2.36. Therefore, 0.68/2.36= 0.29, which indicates very low risk for heart disease. It’s Interesting that I have such low cardiovascular risk given that I eat a high-fat diet rich in cholesterol and natural saturated fats – likely the opposite of what your cardiologist has recommended for better heart health.
- Cholesterol particle size test NMR – a particle size test is the only way to differentiate between more harmful LDL and healthy LDL. If you have elevated healthy LDL, your body is making more to meet your requirements throughout your body and lowering it could be harmful. If possible, ask to include testing for oxidized cholesterol, Lp(a) and Lp-PLA2 – all of which put you at higher risk for CVD.
- High sensitivity C-Reactive Protein (hs-CRP) – the liver makes CRP when there is inflammation in the body, chronic elevation indicates inflammation associated with CVD. Levels should be less than 4.8 mg/L.
- Fasting insulin levels – this measures how well you metabolize the sugar you consume. Chronically elevated insulin levels cause inflammation and weight gain throughout the body. Fasting insulin should be measured in addition to fasting glucose because glucose levels can be kept low by the body overproducing insulin which puts you at greater risk for CVD. Fasting insulin reference range is 20-180 pmol/L.
- Homocysteine – indicates impaired conversion of methionine to cysteine. Chronically elevated levels indicate inflammation associated with CVD. Look for homocysteine levels between 5-15 umol/L.
- Coronary calcium scan – is an xray of the coronary arteries that allows your provider to visualize calcium buildup within the plaques of the coronary arteries. This is a minimally invasive and relatively easy diagnostic to get if it is available in your area.
- Coronary CT (CTA) – is slightly more invasive than a calcium scan because IV contrast is used to obtain a 3D image of the heart via CT scan. This provides high resolution images of the blood vessels supplying the heart and is an accurate diagnostic for heart disease.
- Endothelial function test: this can either be a non-invasive or invasive (intracoronary) test that measures the endothelium’s response to pharmaceutical stimulation. This measures the vessel wall’s ability to dilate appropriately in order to accommodate blood flow. Poor endothelial function can be indicative of cardiovascular risk.
*Note: these values are Canadian metric measurements
HOW TO KEEP YOUR HEART & BLOOD VESSELS HEALTHY
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Regardless of your current cardiovascular status, there are many things we can do to promote cardiovascular system health. These recommendations also happen to help prevent other diseases such as diabetes, cancer and cognitive dysfunction – the body is one whole system, and what is good for one system is good for the other.
- Eat a predominately anti-inflammatory diet – this means maintaining healthy blood sugar levels and eating lots of greens and cruciferous veggies like cabbage and broccoli, which help support detox pathways and antioxidants enzymes. Maintaining good blood glucose and insulin levels is one of the best ways to decrease inflammation and protect your heart and brain from damage. Include foods in your diet that promote the production of nitric oxide (NO), which helps support blood vessel function – beets, garlic, pasture-raised organic animal products, wild seafood, leafy greens, dark chocolate, citrus fruits, nuts and seeds.
- Eat a diet rich in healthy fats – omega-3s from fish and eggs, natural saturated fats from coconut or animal products, and unrefined monounsaturated fats from things like olive oil and avocados. Prioritizing healthy fats in your diet not only provides your brain and organs with essential building blocks for growth and repair but also provides a clean energy source that doesn’t increase blood sugar levels. Additionally, these healthy fats come packaged with other anti-inflammatory nutrients like vitamin D and zeaxanthin that are beneficial for cardiovascular health. Contrary to popular belief, healthy sources of saturated fat actually help improve your LDL cholesterol particle sizes, promoting more of the helpful larger LDL (type A) particles and less of the smaller low-density LDL (type B) which improves cardiovascular risk. The opposite is true for eating a diet high in carbohydrates, which increases more harmful (type B) LDL. The types of fat you eat matter! Eating oxidized fats from vegetable oil or trans fats from fried/overheated foods are incorporated into your cell membranes causing mitochondrial dysfunction, brain fog, weight gain in your midsection and inflammation throughout the body?♀️.
- Refined carbohydrates are not your friend – when you take in too many carbohydrates, especially refined/processed carbs that quickly increase your blood sugar levels, your live takes this sugar and converts it to triglycerides (via de novo lipogenesis), which increases your serum (blood) triglyceride levels. As you have seen above, increases in these triglyceride levels is a sharp indicator of increased risk for cardiovascular disease. This coupled with increased inflammation caused by elevated glucose and insulin in the blood is a recipe for heart disease.
- Avoid fried foods – fried foods and foods that have been heated to high temperatures contain oxidized and trans fats, which are highly inflammatory and run the risk of oxidizing LDL particles in the blood, causing damage to vessel walls. Opt for baking at lower temps and avoid eating out at restaurants as much as possible, as restaurants always use damaged inflammatory vegetable oils like canola and soy for cooking. If you are eating out, ask them to cook your meal in butter or coconut oil.
- Vitamin D and Magnesium – are two important nutrients used by nearly every cell in the body and are essential for optimizing cardiovascular health and immune function. They are also important for regulating the absorption of other minerals like calcium and potassium, which are critical for heart function. Taking even 5 mins per day to get some natural sunlight on your skin is important for vitamin D synthesis. Making this nutrient through photosynthesis is likely more beneficial than taking a supplement. Sunlight on your skin stimulates other bioactive pathways, such as the production of nitric oxide, which promotes healthy contractility of blood vessels. Magnesium is best absorbed through the skin, so opt for natural body care products like magnesium oil or deodorant to moisturize your skin to help optimize these levels.
I hope this information is helpful for you and your loved ones and can help clarify some of the common misinformation around cardiovascular health. As always, reach out to us if you have any questions! We are on Instagram @lolohealthco and on Facebook as LOLOHEALTHCO or lolohealthco@gmail.com
ALLHAT. (2002). Lipid-lowering trial showed no benefit from Pravastatin. Heartwire.
Bikman, D. B. (2020). Why We Get Sick . New York : Benbella Books.
Bowden, J., & Sinatra, S. (2012). The Cholesterol Myth. Beverly, MA: Fair Wind Press.
Castelli, W. (1988). Cholesterol and lipids in the risk of coronary artery disease–the Framingham Heart Study. Canadian Journal of Cardiology , A:5A-10A.
Chou, R., & Dana, T. (2015). Statins for Prevention of Cardiovascular Disease in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA, DOI: 10.1001/JAMA.2015.15629.
Chu, L. (2010). Bioavailable testosterone predicts a lower risk of Alzheimer’s disease. Alzheimer’s Disease, 21(4): 1335-45.
Chuengsamarn, S., & Rattanamongkolgul, S. (2014). Reduction of atherogenic risk in patients with type 2 diabetes by curcuminoid extract: a randomized controlled trial. Journal of Nutritional Biochemistry, DOI: 10.1016/j.jnutbio.2013.09.013.
Cole, D. W. (2019). The Inflammation Spectrum. New York: Penguin Random House .
David, C. G., & Zaccaro, D. J. (2003). Insulin sensitivity and the risk of incident hypertension: insights from the Insulin Resistance Atherosclerosis Study. Diabetes Care, DOI: 10.2337/diacare.26.3.805.
Feinleib, M. (1992). Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. JAMA, doi:10.1001/jama.1981.03310300063026.
Graveline, D. (2006). Lipitor, Thief of Memory. Retrieved from www.spacedoc.com/lipitor_thief_of_memory.html
Hlatky, M. (2008). Expanding the orbit of primary prevention – moving beyond JUPITER. New England Journal of Medicine, 2280-82.
Jakobsen, M. U., & Dethlefsen, C. (2010). Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: the importance of the glycemic index. The American Journal of Clinical Nutrition, 1764–1768.
jeffrey, S. (2002). ALLHAT: Lipid-lowering trial shows no benefit from Pravastatin. Heartwire.
Johns Hopkinds Medicine. (2008). The New Blood Lipids Test- Sizing up LDL Cholesterol. Johns Hopkins Health Alerts.
Katan, M. B. (1995). Dietary oils, serum lipoproteins, and coronary heart disease. Am Journal of Clinical Nutrition, DOI: 10.1093/ajcn/61.6.1368S.
Kendrick, M. (2007). The Cholesterol Con. London: John Blake .
Lehman, S., & Lehman, J. (2015). NNT for Statins vs. the Mediterranean Diet. American Chiropractic Association.
Lorgeril, M. (1999). Mediterranean diet, traditional risk factors and the rate of cardiovascular complications post MI: from Lyon Heart Study. Circulation, 99:779–785.
Lorgeril, M. (2010). Cholesterol lowering, cardiovascular disease and the Rousuvastatin controversy: a critical reappraisal. Archives of Internal Medicine, 1032-36.
Lorgeril, M. (2011). The Near Perfect Sexual Crime, Statins against Cholesterol. France: A4set.
Lundell, D. (2012). The Cure for Heart Disease. Scottsdale: Publishing Intellect.
Meir J. Stampfer, M. F. (2000). Primary Prevention of Coronary Heart Disease in Women through Diet and Lifestyle. New England Journal of Medicine, DOI: 10.1056/NEJM200007063430103.
Mozaffarian, D. (2004). Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women. Am Journal of Clinical Nutrition, DOI: 10.1093/ajcn/80.5.1175.
Ong, H. (2005). The statin studies: from targeting hypercholesterolemia to targeting the high-risk patient. International Journal of Medicine, 599–614.
Pignone. (2000). Primary Prevention of CHD with pharmacological lipid lowering therapy: A meta-analysis of RCTs. British Medical Journal, 983-86.
PREDIMED. (2013). Primary Prevention of Cardiovascular Disease with the Mediterranean Diet. New England Journal of Medicine, 368:1279-1290.
Ravnskov, U. (2010). Ignore the Awkward, how cholesterol myths are kept alive. Seattle: Createspace.
Ridker, P., & Pradhan, A. (2012). Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. The Lancet, Pages 565-571 .
Rosano, G. (2007). Low Testosterone levels are associated with coronary artery disease. International Journal of Impotence Research, 19(2):176-82.
Seman, L. J. (1999). Lipoprotein(a)-Cholesterol and Coronary Heart Disease in the Framingham Heart Study. Clinical Chemistry, Volume 45Issue 7.
Shanahan, D. C. (2017). Deep Nutrition. New York: Flatiron Books.
Shimamoto, K., & Kita, T. (2005). The Risk of Cardiovascular Events in Japanese Hypertensive Patients with Hypercholesterolemia: Sub-Analysis of the Japan Lipid Intervention Trial (J-LIT) Study, a Large-Scale Observational Cohort Study. Hypertension Research, 879–887.
sinatra. (2015). Has statin therapy been oversold? Integrative strategies in Cardiovascular Medicine, 31-33.
Taubes, G. (2001). The Soft Science of Dietary Fat. New york.
Taubes, G. (2011). Is Sugar Toxic? Retrieved from New York Times Magazine.
Toth, P. (2003). Reverse cholesterol transport: HDL’s magnificent mile . Current Atherosclerosis Reports , DOI: 10.1007/s11883-003-0010-5 .
Wolfson, D. J. (2015). The Paleo Cardiologist, The Natural Way to Heart Health. New York: Morgan James Publishing.