Statins, the most sold drugs in the world, are based on incomplete research

It is crucial to have a healthy glycocalyx inside our blood vessels and hearts. Why is that?

• Because it prevents cholesterol, erythrocytes and leukocytes from reaching the endothelial cell membrane, sticking to it and building plaque, 1)
• Because it allows the endothelial cells to receive deliveries of oxygen and nitrogen. Thereby, the endothelial cells will be able to deliver nitric oxide (NO) to the muscular layer of the vessel wall (tunica media), preserving its elasticity, 2) Reduced elasticity of the blood vessels results in reduced possibilities for the erythrocytes to reach the cells for delivery of oxygen to the mitochondria.

Excluding relevant information from a scientific study will result in an inaccurate conclusion. On the following pages, I will show that all national and international approvals of statins have been based on studies that are missing relevant information, which is why all statin approvals should be revoked.

A simple parable
Imagine that you are watering your garden with a hose, and you notice the water slowing to a trickle. Naturally, you would want to know why the water is no longer running smoothly. Is there something in the water that is suddenly blocking the way? Or could there be something wrong with the inside surface of the hose? Let me explain how this pertains to my theory on glycocalyx!

Ever since the days of Ancel Keys, arterial plaque has been explained as a result of too much cholesterol in the blood. Nobody ever considered that the inner surface of the blood vessels might be damaged, allowing cholesterol and leukocytes to stick to the endothelial cell membrane, thus allowing the buildup of arterial plaque.

Where did it go wrong?
The famous American epidemiologist Ancel Keys published a paper about cholesterol from animal fat. Nowadays, it is a reluctantly accepted fact that this paper was based on research fraud. However, in the 1960s, he received support from the American Heart Association (AHA). This led us to believe that too much cholesterol in the blood is the cause of a sharply increasing number of myocardial infarctions. Other consequences:

• We started believing that food containing cholesterol (such as animal fat and eggs) is a threat to our cardiac health.
• We started following the advice published in the official US dietary guidelines of 1977, which recommends us to reduce our intake of saturated fat (fat from animals) and increase our intake of unsaturated, especially polyunsaturated, fat and carbohydrates (sugar, flour and starch).
• We became overweight and fat.
• All kinds of metabolic diseases, such as cardiovascular problems, diabetes, high blood pressure etc, have gradually increased to an alarmingly high level, and they are still increasing.
• The pharmaceutical industry has developed various cholesterol-lowering drugs.
• We are recommended by our doctors to start eating cholesterol-lowering pills for the rest of our lives.

After a while, the pharmaceutical industry and the medical authorities agreed that statins are the very best medicines to reduce cholesterol levels in the blood. In 1987, statins were introduced on the market. Since then, they have grown to become the most profitable drug ever under the following trademarks: Lovastatin, Zocord (simvastatin), Lipitor (atorvastatin), Simvastatin, Crestor (rousovastatin), Fluvastatin, Pravastatin.

To top it off, the official medical treatment guidelines in Sweden stated that statins should be prescribed not only to patients with diagnosed cardiovascular events, but also to patients without any diagnosed cardiovascular events, as a preventive measure.

This is what we got
All studies published since the research fraud of Ancel Keys have been focused on cholesterol as the risk and the cause of plaque buildup on the inside of the arteries. So far, there are no published studies stating a damaged inside surface of the arteries as a possible cause of plaque buildup. There is no doubt that arterial plaque contains a lot of cholesterol. But does that automatically mean that cholesterol is the cause of plaque? At least, this seems to be the consensus. Nobody questioned it!

Nobody considered the fact that the inside surface of the arteries (the endothelial cells) is covered with a hair-like negatively charged surface called glycocalyx, which has three important functions:

• It acts as a flotation bed for the blood.
• It prevents cholesterol, erythrocytes, leukocytes, thrombocytes etc, from coming near and sticking to the endothelial cell membrane.
• It collects and mixes oxygen and nitrogen, enabling the endothelial cells to deliver nitric oxide (NO) to the muscle layer (tunica media) of the arterial wall, which would otherwise lose its elasticity.

When endothelial glycocalyx is high and dense there is no risk of plaque buildup. The glycocalyx must be low and sparse, or even missing, for cholesterol, erythrocytes, leukocytes, thrombocytes etc. to reach and attach themselves to the endothelial cell membrane and start building plaque.

All research has focused on what is running through the arteries: the blood and its content of for example cholesterol. Nobody has included the condition of the glycocalyx on the inside surface of the blood vessels in their cholesterol- lowering studies. They have all focused on cholesterol as the only risk and only cause of plaque buildup.

If the endothelial glycocalyx was consistently high and dense in all humans, there would be no reason to include the status of glycocalyx in cholesterol-lowering studies. However, we know now that the condition of endothelial glycocalyx varies over time, and from individual to individual. As nothing is mentioned about glycocalyx in the large number of statin studies, the authors must have assumed that the condition of glycocalyx does not play any role in the buildup of plaque on the endothelial cell membrane. Now we know that this assumption was and still is wrong.

The medical and scientific journals peer review did not see this
In the process of approving and recommending statins, none of the qualified scientists who peer reviewed the relevant studies commented on the lack of information about the condition of the endothelial glycocalyx, despite its three important functions which are specified above. This should have been done!

The same is true of all studies, published during the last twenty years, reinforcing the message that we must bring cholesterol levels down to avoid cardiovascular problems. Those authors cannot possibly be excused, as the knowledge about glycocalyx was available 3) 4) when they were writing their papers.

Why did it come to this?
One explanation could be that, initially, there was no practical clinical method available to check the inside of the arteries. The clinicians simply did not know that there is a negatively charged hair-like surface on the inside of the arteries, the condition of which is of decisive importance to prevent cholesterol, erythrocytes, leukocytes, thrombocytes etc. from reaching and sticking to the membrane of the endothelial cells. Nowadays, we also know that glycocalyx has a decisive importance for the following:

1. It enables the supply of nitric oxide (NO) from the endothelial cells to

the muscular layer (tunica media) of the vessel wall to preserve its elasticity, 2).

1. The positive electrical signals from the sinus node in the right atrium of the heart must be able to follow the negatively charged surface of a high and dense glycocalyx to the AV node for further transport to the walls of the heart without any signs of atrial fibrillation.
2. It enables the endothelial cells inside the heart to deliver NO to the walls of the heart to uphold its pumping capacity.

Many physicians still have no idea what endothelial glycocalyx is
When I began my studies of glycocalyx I used to ask physicians I met what glycocalyx is. One of the first ten had a vague idea. The others did not have a clue! Lately, during an appointment with his physician, a friend of mine suggested: “Could it be glycocalyx?” The doctor answered that he had “never heard of that medicine”.

When electron microscopy was introduced during the 1960s, J H Luft noticed (PMID: 5927412) a hair-like surface on the inside of the vessels. Unfortunately, there was no practical clinical method to check its condition on patients with circulatory problems. As late as mid 1980, a few years after USA and other countries got their official dietary guidelines, physicians were not aware that this hair-like surface (glycocalyx) on the inside of our blood vessels is extremely important for our wellbeing. They called the inside of blood vessels endothelium, without wondering what the hair-like surface on the outside of every endothelial cell could possibly do for us. Glycocalyx was treated as an integrated part of the endothelial cells (which it is) without any function. This is perhaps the reason why nobody paid, and still does not pay, any attention to endothelial glycocalyx.

The common knowledge was that, on the inside of everyone’s blood vessels, there is endothelium consisting of endothelial cells constituting a cohesive surface. There was no reason to wonder whether the surface of the endothelium glycocalyx could vary in quality over time, between individuals and between various locations in the circulatory tree.

Consequently, nobody considered that the condition of this hair-like surface of the endothelial cells, the glycocalyx, could play a critical role in allowing or preventing buildup of cholesterol, leukocytes and thrombocytes on the membrane of the endothelial cells.

The cholesterol hypothesis must be abolished
During the last forty years, it has been the predominant opinion that too much cholesterol in the blood is the cause of arterial plaque and cardiovascular problems. It is time to get rid of the lipid hypothesis, or at least reduce its importance, and instead focus on glycocalyx. For too many years, the lipid hypothesis has allowed statins to become the number one drug in the world. It is time to acknowledge that cholesterol is not the cause of c/v problems. We should rather look upon cholesterol as one of the causes. The primary cause seems to be shedded glycocalyx. Let us accept that cholesterol is the secondary cause.

An overwhelming majority of Pubmed studies of glycocalyx shedding point at hyperglycemia as a possible cause of glycocalyx shedding. Meanwhile, none of the studies that made statins the most sold and profitable drugs in the world, included any information about the condition of the the participating patients’ glycocalyx. The following conclusions seem obvious:

• Medical authorities should reconsider their approvals of all statins.
• Medical authorities should reconsider their recommendations about what foods are healthy for humans. Everyone should avoid sugar, flour and starch, while adding plenty of dark green and red above-ground vegetables as treatment to grow a healthy glycocalyx.
• Dietary Guidelines should be amended accordingly.

It is obvious that the supply of oxygen to the mitochondria is of utmost importance for the proper function of everything in the human body. Without a healthy glycocalyx, the supply of oxygen to the mitochondria will be negatively affected, resulting in various symptoms, the cause of which your doctor may not be able to explain. You can read more about this in my five previous papers, published during 2021 in the Swedish medical journal “Medicinsk Access” and in more papers to come.

Lasse Blomdahl

• 2008 J M I M Noble 1, A J Drake-Holland, H Vink; Hypothesis: arterial glycocalyx dysfunction is the first step in the atherothrombotic process; Epub Mar 4 ul;101(7):513-8
• 1998 Robert F Furchgott, Louis J Ignarro, Ferid Murad Nobel Prize winners for the explanation of the endothelial cells role in supplying nitric oxide (NO) to the muscular layer (tunica media) of the vessels
• 1998 M Morigi et al, Leukocyte-endothelial interaction is augmented by high glucose concentrations and hyperglycemia in a NF-kB-dependent fashion, J Clin Invest 101:1905-1915
• 2006 Max Nieuwdorp et al,; Loss of endothelial glycocalyx during acute hyperglycaemia coincides with endothelial dysfunction; Diabetes, February vol.55 2021 Dr Malcolm Kendrick; “The Clot Thickens”