BFP Magazine

Cardio-vascular Health

High Blood Cholesterol Level, Heart Attack

Is it Cholesterol or Fibrinogen that causes a Coronary?

By Dr. W. Gifford Jones

Can anyone today escape the worry of a high blood cholesterol level? Newspapers, magazines and television commercials continually preach the dangers of a high cholesterol diet and resulting risk of heart attack. The supposed link of blood cholesterol with coronary attacks has created "Cholesterolphobia" a new national disease. A recent report however, suggests too many people may be worrying about the wrong devil. Perhaps people should be wondering instead about the blood level of fibrinogen? And the blood platelet count.

Dr. Simon Thompson, a British researcher at the Royal Free Hospital in London England, claims blood fibrinogen could be a bigger risk factor than cholesterol. He reported at the International Conference on Preventive Cardiology that males who develop coronary disease have increased levels of fibrinogen, a soluble protein in the circulation, which is instrumental in the clotting of blood.

Dr. Thompson is not the only researcher to link fibrinogen with ischemic heart disease. 5,537 patients were studied in five different centers during which time 458 subjects suffered ischemic attacks. The result? As the fibrinogen levels increased so did the number of ischemic attacks. And in some instances the risk of coronary attack doubled.

These findings are more bad news for smokers. A 60 year old smoker has a 70 per cent greater chance of developing heart disease than a non-smoker. Dr. Thompson suggests that increased levels of blood fibrinogen could account for half the increased risk associated with smokers.

I've always believed that studies would eventually show that blood cholesterol wasn't such a dominating factor in heart attack. In 1983 I reported that Dr. Dale Hammerschmidt at the University of Minnesota postulated that abnormal blood platelets triggered blood clots and coronary deaths.

Hammerschmidt emphasized that in early times the clotting ability of platelets could save primitive man after an attack by a saber-toothed tiger. But humans have changed their environment quicker than platelets have adapted to a different lifestyle. Hammerschmidt said that too much T.V. watching, lack of exercise, smoking and poor nutrition produced abnormal platelets which injured arterial walls and contributed to atherosclerosis.

Now research by Drs. Jan Erikssen and Erik Thaulow in Oslo, Norway, add further credence to this theory. They studied platelet counts on 2,014 healthy males between the ages of 40 and 59 years of age for 13 years. Their conclusion? Subjects with the highest platelet counts had an overall greater mortality rate. They also had double the number of cardiovascular deaths compared with patients with lower platelet counts.

These findings by Dr. Thompson and the Norwegian researchers help to explain some of the imponderables surrounding coronary deaths. For instance, why many patients who succumb to heart attack have normal blood cholesterol. Why Dr. Michael Debakey, the famous heart surgeon, finds that 30 per cent of his patients with extensive atherosclerosis have normal blood cholesterol. Why Scottish males living in Edinburgh have three times the rate of coronary heart disease of Swedish males, but their cholesterol levels are the same. Why Japanese males living in California have two to three times the rate of CHD of Japanese males living in Japan. There is more to a heart attack than the level of blood cholesterol. But this message never gets through to the general public.

How can you keep fibrinogen and platelets healthy and well-oiled to prevent a fatal blood clot? First of all give up smoking. Dr. Simon Thompson reports that fibrinogen levels drop slowly over a period of years when people stop smoking. But increase again when smokers return to the habit. Norwegian researchers similarly found that the high platelet group contained a higher number of smokers.

Dr. Hammerschmidt says that increased consumption of garlic, onions, common culinary vinegar and Chinese black fungus keeps platelets healthy and lowers the risk of atherosclerosis and heart attack. It's also wise to eat more fish and less meat. Marine fish such as mackerel, cod and salmon contain a substance called EPA which helps to lubricate platelets. But for patients in a high risk category aspirin is the most effective agent to stop platelets from sticking together.

Of course a healthy lifestyle should be placed at the top of the list and this is where we are failing badly. According to the President's Council on Physical Fitness in the U.S. today's children are in worse shape than 20 years ago. A recent council study reported that 40 per cent of children aged five to eight have at least one of the following risk factors for heart attack, hypertension, increased blood cholesterol and low cardiovascular capacity.

It's astounding that half of North American girls aged 6 to 17 and 30 per cent of boys of the same ages can't run a mile. And 55 per cent of girls and 25 per cent of boys can't do a single push-up! I'd bet ten-to-one they also have high fibrinogen and platelets levels. 

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: He can be reached at

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