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Heart Attacks and Cholesterol: Dying Under Normal Circumstances

Most people hospitalized with heart attacks have cholesterol levels considered “desirable” under the current recommendations. Having a “normal” cholesterol in a society where it’s normal to die of heart disease is not necessarily a good thing.

December 19, 2011 |
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Supplementary Info

Sources Cited


Image thanks to Alex Proimos.


The current official recommendation is to have a total cholesterol under 200. Over 240 is considered high, 200 to 239 borderline high, but under 200 is desirable. So you’d imagine that the average cholesterol of people who have heart attacks is 250, 300, somewhere in the high range—that’s where it’s dangerous, right?
A major study was published in the American Heart Journal this year. 65,000 people hospitalized with acute coronary syndromes, like myocardial infarctions—heart attacks, across 344 hospitals. Guess what their average cholesterol was on admission. 170.
If you went to a doctor worried about your heart—maybe you have heart disease in your family, or you're feeling your diet hasn't been the greatest—and your cholesterol came back at 170, well within the quote-unquote “desirable range,” your doctor would probably pat you on the back, tell you to keep up the good work and send you on your merry way. Based on this new data, the next time you see them, may be when you arrive in the ambulance if you’re lucky enough to make it that far.
Most people admitted to hospitals with heart attacks have quote-unquote normal cholesterols. Having a “normal” cholesterol in a society where it is normal to… drop dead of heart disease, is not necessarily a good thing. Desirable cholesterol levels leave a lot to be desired.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring watch the above video. This is just an approximation of the audio contributed by veganmontreal.

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Dr. Michael Greger

Doctor's Note

Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Be sure to check out all the videos on heart disease.

Be sure to check out my associated blog posts for more context: Generic Lipitor is not the answer to our heart disease epidemicStool Size and Breast Cancer Risk, and Biblical Daniel Fast Tested.

  • Michael Greger M.D.

    Please feel free to post any ask-the-doctor type questions here in the comments section and I’d be happy to try to answer them. Be sure to check out all the videos on heart disease.

    And check out my associated blog post “Generic Lipitor is not the answer to our heart disease epidemic.”

  • CapeBreton

    Something odd here. If the ER patients with CV problems had a TChol of 170, well bellow population average, that suggests lower cholesterol is worse?? The cholesterol “skeptics” will be all over that one…..

    • Michael Greger M.D.

      The principal investigator of the study concluded the opposite (in the accompanying UCLA press release): “Almost 75 percent of heart attack patients fell within recommended targets for LDL cholesterol, demonstrating that the current guidelines may not be low enough to cut heart attack risk in most who could benefit.” See my videos New Target Cholesterol and Eliminating the #1 Cause of Death and stay tuned–I stay on this subject all week. Thanks for your comment!

  • flabuzz

    Hi: did the people in the study have “normal” cholesterol because they had taken drugs? How low does your cholesterol have to be to be heart attack proof? Thank you!!!

    • DrDons

      Hi flabuzz, I’m not sure what normal cholesterol is… I have come to believe it is what your cholesterol is with zero intake of transfat, saturated fat and cholesterol… that of a whole food plant based diet. See recent video.. The heart attack proof levels are said to be a total cholesterol of less then 150 or an LDL below 90…although some would push the LDL number lower. Hopefully future studies using involving larger numbers will help provide better answers.

  • CapeBreton

    That lower than average cholesterol intrigued me enough to do some research. It turns out that with a Western diet the TChol follows an umbrella shaped curve over a lifetime, getting lower, often significantly with age. So old sick people who followed a high fat, high animal food diet will have much lower cholesterol levels with older age, together with a lifetime of arterial plaque that becomes unstable too with age.

    In Japan at least the cholesterol levels are lower throughout life(with a trad diet) and don’t drop off with age.

    See Circulation 1978 58:3-19

    Flabuzz, 150 is usually given as the magic number based on Framingham study, 3.9 in units used outside of US

  • kjcreate

    British Medical Journal (April ’11) study of 16,718 women: Intake of a combination of calcium and Vit. D*, increased heart health risk (attacks and strokes)by 13-22%. I am a small framed 60 yr old vegan female, who takes 1200 mg a day of both CA and Vit D, in liquid form. What alternative do I have to supplement my diet? *risk remianed with or without Vit D

    • DrDons

      Hi kjcreate, The outcome we are hoping to effect with calcium +/- Vit D is to avoid fractures. It appears that vegans have the same bone density as omnivores at least in buddhist nuns see and it is apparent that both vegans and nonvegans have some difficulty meeting requirement of 600 mg per day see The best way to get your calcium is by eating your greens. Dr. Amy Lanou’s book, Building Bone Vitality, is an excellent book on bone health. It makes a good case for the need to look at the effect of what we eat on taking calcium out of the bone in addition to meeting our intake needs. Although “the Acid/Base hypothesis” was not supported in a recent metaanalysis see, metaanalysis’s although popular due to being quick and low cost they are fraught with the difficulties of pooling studies. One clear cut intervention which has been shown to relate to less fractures is weight bearing exercise. So we should supplement our consumption of greens with a good walking program.

  • MacSmiley

    I can not find this video on yor YouTube account. Michael (Sorry, my old Palm smartphone can’t play videos here on your website.)

    • Michael Greger M.D.

      I’m sorry the site isn’t compatible with your phone. I’ve tweeked the youtube settings to make it public for your viewing pleasure. :)

      • MacSmiley

        Thanks Doc, but for some reason there is still no video between the Neti pot video and “Heart attacks and cholesterol: Agribusiness sees it differently” on your YouTube homepage.

  • MacSmiley

    More weirdness: that search link took me to your profile page. So I did my own search and came up with a direct URL which I’ve shortened:

    Thanks again.

  • Sharolyne

    Is there a way to see more than just the abstract of this study?  Also, I recently saw a news report of a study that suggested taking vit D supplements can actually raise cholesterol levels   My cholesterol levels have been in the 230-240 range since the first time I had them checked.  In an attempt to lower levels I did a vegan diet for 1 year.  At the same time  I discovered my vit D levels were low and for 6 months of the vegan year took 50,000u vit D.  At the end of the year I had cholesterol level rechecked and it actually went up to 263! 

  • Sharolyne

     addendum to above…I took 50,000u of vit D per week

  • Cat Dat

    I read the study. A little over 41 percent of the people who made up this average of 170 were already on lipid lowering therapy. So they had high enough cholesterol at some time in the past to warrant LLT.

  • Cat Dat

    Also, over 16% had prior heart attacks and almost 70% were hypertensive.

  • Cat Dat

    Sorry, over 19%, not 16%, had prior MI.