You would probably think that there is a positive relationship between FAT and cardiovascular mortality. Fat is bad and must be avoided if we want to live a long and healthy life. That’s what we’ve been conditioned to “know” since the 1950s, so much so, that we now “intuitively know” that FAT is BAD !!! VERY BAD !!! Say "FAT" and the kneejerk reaction is "BAD." Well, HOW WRONG can we be. We’ve been barking up the wrong tree for decades.
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No, Fat is not Bad
You can’t be blamed for believing that fat is bad for you. After all, your doctor told you so many times and the "cholesterol-is-BAD for you" industry is trying to push cholesterol-lowering statins through the throats of an increasing number of perfectly health people. The European bureaucratchiks, working in tandem with their national counterparts, have been issuing Directive after Directive, Regulation after Regulation, advice after advice to put pressure on and coerce the food industry to REDUCE FAT ! They designed “nutrient profiles” to separate healthy from unhealthy or undesirable food-products, with low-fat products on the healthy side of the fence. The result is that we all "know" that FAT is BAD !
Well, HOW VERY WRONG !
Fat and survival benefit in cardiovascular patients
A team of 15 scientists of the department of Internal Medicine of the Mayo Clinic in America, working under supervision of Dr. Mohammed Yousufuddin, assistant professor of Medicine, recently debunked the FAT is BAD myth. The Mayo Clinic has one of the oldest and most advanced medical record systems in the USA. Patient-provided information is constantly updated at every clinic or hospital visit at its main campus and at a network of clinics and hospitals across more than 60 communities. During a vast review of this data-base and the scientific literature concerning cardiovascular mortality, the Mayo-team came across several recent studies that found that a high level of fat as measured in the blood (also known as ‘hyperlipidemia’) produces “an overall survival benefit in patients with established acute myocardial infarction and heart failure.” Yes, you read that correctly. Fat produces a survival benefit in cardiovascular patients ! These hyperlipidemic patients live longer than patients who follow a low-fat or no-fat diet. A good reason to look at Mayo Clinic’s data-base.
They couldn’t believe it
To their big fat surprise, Dr. Youssufuddin and his co-workers found a significant “survival benefit” where they had expected to find a survival disadvantage. They gave the article they published in the British Medical Journal the name ‘Association between hyperlipidaemia and mortality after incident acute myocardial infarction or acute decompensated heart failure’. ([i]) Technically speaking, this association was “inverse,” meaning that the hyperlipidemia diminishedmortality ‒ lenghtened life ‒ in the group of patients who had survived a myocardial infarction or heart failure. The patients with high levels of fat lived longest. You may very well interpret this as saying that the patients with high levels of low density cholesterol (LDL) lived longest. The fact that the reviewers characterized these findings as ‘counterintuitive’ shows how deep the myth that FAT is BAD has penetrated not only our minds, but also the minds of respectable scientists.
Effects on all-cause mortality
Triggered by these outcomes, Dr. Youssufuddin and his team decided to see if the survival benefits found in the cardiovascular patients could be associated with other fields of health. They began digging through Mayo Clinic’s medical records and the most recent medical publications, thinking that “if a diagnosis of hyperlipidemia decreases the mortality after acute myocardial infarction or heart failure, then, it also lessens the magnitude of mortality risks associated with other competing comorbidities.” Comorbidities are diseases of factors other than cardiovascular conditions that also contribute to mortality.
Significantly fewer deaths
The Mayo team found that “a diagnosis of HLP (HyperLiPidemia / FAT), compared with no HLP, was associated with 24% and 20% relative risk reduction in all-cause mortality corresponding to 27 and 39 fewer deaths per 1000 person-years after acute myocardial infarction and acute decompensated heart failure, respectively.” Meaning that the survival benefit caused by HLP in cardiovascular patients was so significant that it offset the survival disadvantage associated with other diseases that contribute to overall mortality. In other words, and as expected, the researchers found that cancer, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), diabetes mellitus, heart failure, or stroke, were all significantly associated with increased mortality. However, “this increased risk was offset by the lower mortality from HLP resulting in attenuation or even a null effect on mortality in patients with acute myocardial infarction or heart failure who had HLP concurrent with other comorbid conditions.”
Who benefits from hyperlipidemia ? The Mayo-team found that “the association was consistent across the following subsets: young and old, male and female, white and non-white, and prevailed across both [infarction and heart failure] study cohorts. The reductions in mortality were independent of benefit attributable to statin therapy.” You may wish to read the last sentence again … “the reductions in mortality were independent of benefit attributable to statin therapy.” Whether or not you take statins, the survival benefits of hyperlipidemia occur in any case. Indeed, that contradicts what most doctors, mainstream scientists and health bureaucratchiks “intuitively” know.
Mayo Clinic’s conclusions
The Mayo team’s conclusions are diplomatically worded, wherefore they need some explanation. “The findings of this study,” according to the team, “if validated, should reinforce the importance of HLP in predicting long-term mortality after myocardial infarction or heart failure and potentially provide guidance for subsequent management.” Meaning that you better watch your fat intake, not to lower it, but allow fat to be a normal and perfectly healthy part of your daily diet. Fortunately, HLP can readily be diagnosed and help cardiovascular patients with lower long-term mortality. Meaning that when you find low or no fat in the blood, you may want to up the ante.
Mayo Clinic’s Advice
“In these patients,” states the Mayo team, “clinical care should not focus on certain lipid targets, rather evidence-based secondary prevention strategies should be initiated.” Since “lipd-targets” means cholesterol, statins are contra-indicated after acute myocardial infarct or heart failure. “Conversely,” so says the Mayo study, cardiovascular patients without HLP “may be considered to have increased risk for early mortality and potentially alert providers for close monitoring during hospitalisation and after discharge.” Meaning: don’t avoid fat ! Do avoid cholesterol-lowering drugs. In the careful words of the Mayo-team, cardiovascular patients “would profit from thoughtful tailored programme” with attention focused not only on the cardiovascular conditions, but also on other conditions that must be taken care of on their own merits.
OPCs and antioxidants ?
One word of caution. Fats may turn rancid when they are exposed to oxidation. In their oxidized, rancid, state, fats are not beneficial. The body doesn’t recognize them as fats and tries to eliminate them as intruders. Oxidized fats can no longer be carried away from the vascular wall, where they have been “sequestered” and sealed off by white blood cells. This is how rancid, oxidized, fat can initiate the plaque that can lead to cardiovascular problems. So, although fat produces a survival benefit in cardiovascular patients, the thoughtful dietary management of fat-intake should be accompanied by the management of an equally thoughtful dietary management of anti-oxidants. In this regard, the vitamins E and C, and, of course, OPCs should be part of “the menu.” As Dr. Jack Masquelier said: “Any substance that prevents what is called lipoprotein oxidation will reduce this danger of plaque formation. We can prevent heart attacks thanks to antioxidative substances and OPCs are the type of substance that may prevent LDL from becoming oxidized.”
[i] Yousufuddin M, Takahashi PY, Major B, et al. Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis. BMJ Open 2019; 9:e028638. doi:10.1136/bmjopen-2018-028638