So far we have been looking at cholesterol lowering in terms of numbers of deaths, but the trials
have shown impressive results in the reduction of non-fatal heart attacks and a consequent
improvement in the quality of life. In the case of drugs, the reduction was in the order of twenty-three percent. Many see this as proof that lowering cholesterol in the total population, by
whatevewhatever means, is worth fighting for.
But those trials were conducted on men rather than women. They were also conducted on
those who had hypercholesterolaemia or, at least, very high blood cholesterol levels - not people
with normal levels. They totally overlook the now well-established, non-linear relation between
blood cholesterol and heart disease that indicates that lowering blood cholesterol in the general
population is not economically worthwhile. The widespread agreement that the mainstay of the
campaign should be a change in diet and lifestyle for all also overlooks the complete lack of
evidence that such a course would have any significant beneficial effect. It even overlooks the
fact that the trials involving cholesterol lowering by dietary means did not show any significant
reductions in blood cholesterol.
In 1992 a report of 19 major studies published over the past twenty years suggested that public
policy for reducing blood cholesterol should be reviewed. The graph below plots the relative
mortality risk from all causes associated with levels of blood cholesterol in men and women. In
the case of women, you can see clearly that risk rises as blood cholesterol falls. The report's
author, Dr. Hulley, states:
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"We are coming to realise that the resulting cardiovascular research, which represents the
great majority of the effort so far, may not apply to women".
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With men, the situation is more complicated as the curve is U-shaped. However, it is still
noticeable that the risk with low cholesterol is similar to the risk with high cholesterol. Dr.
Hulley concludes:
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"the findings call into question policies built over several decades on evidence that focussed
only on CHD as an outcome . . . it may be time to review national policies aimed at shifting the
entire population distribution of blood cholesterol to the left."
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Another analysis based on a number of American studies estimated that on a lifelong
programme of cholesterol reduction by diet, the gain in life expectancy for those at very high
risk (that is the 1 in 500 with hypercholesterolaemia) would be between eighteen days and
twelve months, and for those at low risk (that is the other 499) between three days and three
months. That is not very much with which to tempt people to endure a lifetime of unpalatable
diets. And these figures assumed that cholesterol lowering was both effective and safe: they
didn't take into account the increased risk of other debilitating and fatal diseases. Once these are
added to the equation, it becomes quite evident that the current campaign is certain to do more
harm than good. A study of Maori in New Zealand showed that those with the lowest levels of
blood cholesterol had the highest mortality. Findings also borne out by the Framingham Study.
What we have then is a number of very large-scale, long-term human intervention studies
showing that lowering blood cholesterol is possible but that it has no beneficial effect on
coronary heart disease in the general population, and other studies showing that a low blood
cholesterol level, or the methods used to attain it, are increasing the incidence of other serious
killer diseases.
Thirty years ago it was said that
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"current medical thinking . . . is that while cholesterol may be involved in some way with
arteriosclerosis and heart disease, it is no longer held to be the main factor." . . . "A recent
survey of cholesterol findings in geriatric cases involving arteriosclerosis showed a significant
number of patients to have normal or low cholesterol."
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Those remarks have been confirmed by all the major studies published to date. Forty years
after the Framingham Heart Study began, its researchers looked at total mortality and
cholesterol. The evidence was that for those with low cholesterol levels, deaths from non-cardiac
causes offset any reduced incidence of heart disease. There was "no increased overall mortality
with either high or low serum cholesterol levels" among men over forty-seven years of age.
There was no relationship with women older than forty-seven or younger than forty. The
researchers also concluded that people whose cholesterol levels are falling may be at increased
risk.
And ten years later the Framingham researchers say: "Intakes of fat and type of fat were not
related to the incidence of the combined outcome of all cardiovascular diseases or to total or
cardiovascular mortality." Thus we now have fifty years of studies all demonstrating that animal
fat is harmless.
Part 7: So Where Does That Leave Heart Disease?
Back to index
By Barry Groves
For more articles by Barry Groves exposing dietary and medical misinformation see Second Opinions
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