Published 16 September 2008, doi:10.1136/bmj.a1681
Cite this as: BMJ 2008;337:a1681

Letters

Hypercholesterolaemia

Should medical science ignore the past?

For their article on hypercholesterolaemia and its management Bhatnagar et al selected reviews only if they included "extensive recent references,"¹ thereby missing important knowledge from the past [full list of references in rapid response].² Let me elaborate:

• No association between cholesterol and degree of atherosclerosis has been found in postmortem studies of unselected individuals
  
• High cholesterol is not a risk factor for women, patients with renal failure, diabetic patients, or old people³
  
• Old people with high cholesterol live longer than those with low cholesterol³
  
• In cohorts of people with familial hypercholesterolaemia, cholesterol is not associated with the incidence or prevalence of cardiovascular disease, and their average life span is similar to other people’s
  
• No randomised, controlled, unifactorial, dietary, cholesterol lowering trial has ever succeeded in lowering coronary or total mortality⁴
  
• No clinical or angiographic trial has found exposure-response between individual degree of cholesterol lowering and outcome³
  
• More than 20 cohort studies found that patients with coronary heart disease ate the same amount of saturated fat as did healthy controls⁴
  
• Seven of 10 cohort studies found that patients with stroke ate less saturated fat than did healthy controls
  
• The concentration of short chain fatty acids in adipose tissue, the most reliable reflection of saturated fat intake, is similar or lower in patients with coronary heart disease compared with healthy individuals in five case-control studies
  
• The effect of statin treatment is grossly overstated and is not due to cholesterol lowering.³ Only a small percentage gain benefit—and then only if they are men at high risk—and the benefit is easily outweighed by side effects that are more common and more serious than reported in the statin trials, if reported at all.⁵
  

Revision of the cholesterol campaign by scientists without links to the food or drug industry seems urgent.

Cite this as: BMJ 2008;337:a1681

¹ Magle Stora Kyrkogata 9, 22350 Lund, Sweden

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Competing interests: None declared.

References

1. Bhatnagar D, Soran H, Durrington PN. Hypercholesterolaemia and its management. BMJ 2008;337:a993. (21 August.)[Free Full Text]
2. Ravnskov U. Rapid response to: Hypercholesterolaemia and its management. bmj.com 2008. www.bmj.com/cgi/eletters/337/aug21_1/a993#201600
3. Ravnskov U. High cholesterol may protect against infections and atherosclerosis. Q J Med 2003;96:927-34.[Web of Science]
4. Ravnskov U. The questionable role of saturated and polyunsaturated fatty acids in cardiovascular disease. J Clin Epidemiol 1998;51:443-60.[CrossRef][Web of Science][Medline]
5. Ravnskov U, Rosch PJ, Sutter MC, Houston MC. Should we lower cholesterol as much as possible? BMJ 2006;332:1330-2.[Free Full Text]

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Relevant Articles

Hypercholesterolaemia and its management

Deepak Bhatnagar, Handrean Soran, and Paul N Durrington
BMJ 2008 337: a993. [Extract] [Full Text]

Should we lower cholesterol as much as possible?

Uffe Ravnskov, Paul J Rosch, Morley C Sutter, and Mark C Houston
BMJ 2006 332: 1330-1332. [Full Text] [PDF]

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