Cholesterol: the dogma crumbling as a new paradigm emerges

Cholesterol: the dogma crumbling as a new paradigm emerges

Is cholesterol really the culprit behind heart attacks, or have we spent decades looking in the wrong place? For years we were told that high cholesterol, especially LDL, clogged the arteries like lime in a pipe. But a growing number of medical professionals and studies are questioning that narrative, and the shift runs deeper than it seems.

The classic theory, consolidated in the 1970s and 80s, held that dietary cholesterol and elevated blood levels were the main cause of atherosclerosis. However, recent evidence suggests the process is far more complex. Several cardiologists and endocrinologists now argue that cholesterol is not the causal agent but a repair crew that arrives at damaged arteries. The real problem would be inflammation of the endothelium — the inner lining of the vessels — caused by factors such as excess sugar, insulin resistance or oxidative stress.

Inflammation, not cholesterol, as the trigger

The argument gaining ground is this: atherosclerosis does not begin because cholesterol is deposited, but because the endothelium is injured. When the arterial wall becomes inflamed, LDL cholesterol arrives to repair the damage. If the inflammation persists, it accumulates and forms plaque. Cholesterol, then, would be a firefighter responding to the fire, not the arsonist. This view is defended by physicians such as Dr Carlos Hernández and Dr Sergio Mejías, whose videos circulate in circles critical of the dogma.

In fact, it is pointed out that up to 75% of heart attacks occur in people without elevated LDL cholesterol according to traditional risk thresholds. A figure that calls into question the usefulness of statins as universal prevention.

The fraud at the origins and the role of sugar

The story of how cholesterol theory was built is, to say the least, murky. Fraudulent studies are mentioned, as well as others bought by the food industry to demonise fats and protect sugar. One of the most famous cases is Ancel Keys' study, which selected only the countries that fit his hypothesis, ignoring those that contradicted it. Meanwhile, research pointing to sugar as the culprit was silenced or defunded.

Today, many specialists argue that the true cardiovascular risk factor is insulin resistance, a metabolic state that affects most of the population to a mild degree. When resistance is present, excess glucose in the blood causes glycation of LDL cholesterol, making it more prone to oxidation and accumulation. That is why a person with high LDL but no insulin resistance may face no greater risk, while another with resistance and normal LDL can suffer a heart attack.

The paradigm shift is slow but unstoppable. Eggs — rich in cholesterol — are no longer demonised, and doctors who once banned yolks have publicly apologised. The question that remains is: how long will it take the official medical consensus to catch up? Meanwhile, the mantra of "eat less fat and more grains" sounds more and more like an echo of another era.

The numbers don't add up, and the patient who wants to prevent a heart attack would do well to look beyond total cholesterol. Look at inflammation, at insulin and, above all, at sugar.