Cholesterol: how low is low enough?

BMJ 1999;318:538 ( 20 February )

Letters

Cholesterol: how low is low enough?

Effect of a given concentration depends on several factors

Doctors have been slow in getting evidence on lowering cholesterol into practice

Effect of a given concentration depends on several factors

The first 150 words of the full text of this article appear below.

EDITOR $---$ In his editorial Rosengren considers that reaching target cholesterol concentrations may be better than relative reductions.¹He stated that "in observational studies a prolonged differencein usual serum cholesterol value of 0.06 mmol/l is associatedwith an almost 30% reduction in risk of coronarydisease."

No one would question the need for reducing serum cholesterol concentration in large proportions of adults in Western populations.However, the subject of cholesterol concentration and its pathologicalimportance iscomplex.

Known risk factors for coronary heart disease, of which serum cholesterol concentration is one, explain only half of the variancein the occurrence of the disease.² There are also numerouscontextual problems. For example, in the Sheffield risk table,cholesterol reduction may be called for at 5.5 mmol/l in thoseat high risk, whereas intervention may not be needed until 9.0mmol/l in those at low risk.³ The experience of coronary heartdisease also . . . [Full text of this article]