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Hidden Epidemic: Heart Disease in America
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Chapter 6: Cholesterol's Secrets [8:11]

A high level of LDL cholesterol is linked with heart disease. Why? The quest for answers unlocks profound insights.

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Transcript: Chapter 6 - Cholesterol's Secretes

A high level of LDL cholesterol is linked with heart disease. Why? The quest for answers unlocks profound insights.

NARRATOR: Every two years since 1948 Victor Galvani has returned faithfully to the Framingham heart study for a checkup.

VICTOR GALVANI: And I look forward to it and I'm always curious as to what new testing I might be submitted to tomorrow. It's been a great program.

NARRATOR: Vic has not been free of heart disease. He's survived bypass surgery and a blocked artery in his neck.

NARRATOR: At the age of 92, he's one of fewer than 400 of the original 5,000 study participants still living.

DR. WILLIAM KANNEL: I think our surviving cohort have been wonderful, and deserve all the credit they can, I think it's now a contest actually between the senior investigators and the cohort to see who'll survive longer.

PAUL GALVANI: The incredible thing about my father is he's outlived his first two cardiologists. And he's—he's still going pretty strong at 92, so hopefully I can be in the same position.

NARRATOR: Vic's son and many other members of the Galvani family are also in the study.

NARRATOR: Paul joined in 1971, when the Framingham researchers added their second generation of volunteers the sons and daughters of the original group

PAUL GALVANI: One of the things my father emphasized it not only benefits from the research end of it but knowledge of your own condition is certainly helpful.

NARRATOR: The second generation volunteers were going to help launch a new and hotly contested phase of the study. It was a major investigation into something most people knew nothing about, but that would turn out to be one of the most critical pieces of the heart disease puzzle. It's a mystifying substance, which flows through the bloodstream with deadly potential—cholesterol.

Cholesterol is a normal ingredient in the body that's used to help create the membranes of cells. The body makes all the cholesterol it needs on its own. Food with high fat content adds the rest. By 1965, Framingham data was hinting that somehow, there was a connection between heart disease and the amount of cholesterol in the blood of an average American.

DR. DANIEL LEVY: Many people confuse average with normal or desirable. Average person in the United States faces a considerable risk for developing heart disease and stroke. Being average is not a desirable trait.

DR. WILLIAM CASTELLI: Prior to 1965 you only had to know one cholesterol in America—300. Everyone else was told they were normal. Now when you're at 300, it's a devastating risk.

NARRATOR: There are two major kinds of cholesterol—HDL and LDL. HDL is known as the good cholesterol and LDL as the bad. LDL is normally kept in check by receptors in the liver, which help metabolize it. But these receptors can't handle an excessive amount, and where there's too much LD in the blood, it binds with other to create waxy plaques that eventually travel through the bloodstream and clog the arteries in the heart. It took years of research for these basic facts to come into focus. But as they did, something else became clear- high cholesterol levels seemed to be a distinctly American problem.

DR. STEVE NISSEN: We started to look at populations in other countries where the diet was different, like China. And you'd find that the average cholesterol level would be 150, and they had almost no coronary heart disease.

DR. WILLIAM CASTELLI: You work in the fields 12 hours a day, eating rice, beans, tofu, veggies three times a day, meat twice a year. Total cholesterol 127. Heart attack rate zero.

NARRATOR: After almost 20 years of research, the accumulation of all these studies pointed to one clear conclusion—high cholesterol, especially high LDL, was a significant risk for heart disease. The fatty American diet seemed to be a big part of the problem. An even bigger problem was getting doctors to accept that this was something they should take seriously.

DR. STEVE NISSEN: There was an incredible reluctance. There was this almost professional group of skeptics that didn't believe it.

DR. WILLIAM CASTELLI: We were having all these trials lowering cholesterol, and all the anti-cholesterol groups were picking them apart, saying, oh, it's not the best science, or oh, you could have done this better or that better.

DR. PETER LIBBY: The argument eventually wasn't so much that cholesterol is humbug, but that, so what? If high cholesterol correlates with cardiovascular risk, at least in a population, it may not do so for a given individual. And even if it did, so what? What can you do about it?

NARRATOR: It wasn't until 1987 that the first drug to do something about cholesterol, called a Statin, became available. Statins work by helping the liver clear cholesterol out of the body.

DR. STEVE NISSEN: And people began to treat a few patients with the statin drugs. But we really didn't know whether we were doing them very much good or not.

NARRATOR: It took seven years to get an answer. Dallas, November 1994. At the annual meeting of the American Heart Association, an international trial of patients who took statins to try to avoid heart attacks was scheduled for release. It was the moment thousands of doctors had been waiting for.

DR. PETER LIBBY: I actually had the privilege of being present at that meeting where the results were unveiled. One of the individuals who had been a very vigorous opponent of the cholesterol hypothesis was in the audience, and, as I recall, he stood up and said, "Gentlemen, I have to hand it to you."

NARRATOR:The results if the trial were a breakthrough in preventative cardiology. It was clear that lowering cholesterol with medication lowered the risk of heart disease. As research continued, what was considered a normal cholesterol level was re-evaluated, and pushed way below the old guideline of 300. Today, a healthy total cholesterol reading is closer to 200.

DR. STEVE NISSEN: And actually, you know, this insight has just taken the cardiovascular community by storm. So it's been an extraordinary period of time.

NARRATOR: Over the last 50 years discovery after discovery proved that out of all the risk factors for heart disease cholesterol played the most significant role. Eventually, I would be the key to even more profound insights that would redefine the entire field of Cardiology.

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