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NEWS ROUNDUP: Deborah Josefson Cholesterol guidelines will triple numbers taking drugs BMJ 2001; 322: 1270a [Full text]

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Wow!

Ron Law   (25 May 2001)

New guidelines for converting healthy people into patients

Uffe Ravnskov   (28 May 2001)

Iron Hypothesis? Needles vs. Statins?

Bradford Roberts   (1 June 2001)

Wow! 25 May 2001
Ron Law Send response to journal: Re: Wow!	What a rort!!! How can the dietary supplement industry get on this wonderful government funded marketing agency called NIH? It just goes to show how objective public-health policy is when the number of otherwise healthy individuals on toxic drugs can be increased by 300% by the stroke of a pen. Readers might also like to read recent research about the ability of vitamin supplements to reduce the risk of heart disease without the risks associated with drugs. See the abstract at http://www.clinchem.org/cgi/content/abstract/47/6/1001 I doubt we'll see any policy recommending cheap supplements not funded by the state and not requiring medical consultations. I'm not a cynic -- just an observer of the fact that public illness policy officials are not driven by a desire to either reduce reliance on expensive pharmaceuticals or expensive vists to the doctor.
New guidelines for converting healthy people into patients 28 May 2001
Uffe Ravnskov, None Magle Stora Kyrkogata 9, S-22350, Lund Send response to journal: Re: New guidelines for converting healthy people into patients	The National Cholesterol Education Program is based on the assumption that it is possible to prevent cardiovascular death in a large number of people. The expert panel´s main argument for the new guidelines is that twenty percent of patients with coronary heart disease have a new heart attack after ten years.1 To reach that number any minor symptom without clinical significance has been included. Most people survive even a major heart attack, many with few or no symptoms after recovery. What matters is how many die and this is much less than twenty percent. . No doubt, the statins lower the risk of dying from a heart attack, at least in patients who already have had one, but the size of the effect is unimpressive. In the CARE trial for instance, the odds of escaping death from a heart attack in five years for a patient with manifest heart disease was 94.3%, which improved to 95.4% with statin treatment.2 For healthy people with high cholesterol the effect is even smaller. In the WOSCOPS trial, the figures were 98.4% and 98.8%, respectively.2 These figures do not take into account possible side effects of the treatment. In most animal experiments the statins, as well as most other cholesterol-lowering drugs, produced cancer, and they may do it in human beings also.2 In the CARE trial breast cancer was seen significantly more often in the treatment group. In the EXCEL trial the increase of total mortality in the treatment group after just one year was borderline significant.3 Unfortunately the trial was stopped before further observations could be made. The original 1961 advice from the American Heart Association to eat as much polyunsaturated fat as possible has been reduced successively to the present “up to ten per cent”. But why this limit? Ten years ago the main author of the new guidelines stated that “intakes above 7% of total calories seemingly cannot be advocated with prudence” because, as he argued, an excess of polyunsaturated fat may be carcinogenic in human beings, just as they are in experimental animals.2 4 Besides, the benefits of manipulating dietary fats have never been proved.2 Instead of preventing cardiovascular disease the new guidelines may transform healthy individuals into unhappy hypochondriacs obsessed with the chemical composition of their food and their blood, undermine the art of cuisine, destroy the joy of eating, and divert health care money from the sick and the poor to the rich and the healthy. 1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA 2001; 285: 2486-2496. 2. Ravnskov U. The Cholesterol Myths. New Trends publishing, Washington DC 2000. 3. Bradford R H, Shear C L, Chremos A N, Dujovne C A, Franklin F A, Grillo R B, Higgins J, Langendorfer A, Nash D T, Pool J L, Schnaper H. Expanded clinical evaluation of lovastatin (EXCEL) study results. Arch Intern Med 1991; 151: 43-49. 4. Grundy SM. George Lyman Duff Memorial Lecture. Multifactorial etiology of hypercholesterolemia. Implications for prevention of coronary heart disease. Arteriosclerosis 1991; 11: 1619-1635.
Iron Hypothesis? Needles vs. Statins? 1 June 2001
Bradford Roberts Send response to journal: Re: Iron Hypothesis? Needles vs. Statins?	Efforts to prevent heart disease by transforming people into patients ignore the much more cost effective approach of blood donation. Blood donation costs the patient nothing, has no side effects, is startlingly effective (>30% reduction in risk in men who've never smoked) and serves a greater social good. As has already been pointed out, statins provide a much more modest benefit at a much higher cost (perhaps as much as half a million US dollars per event prevented) while putting some patients at risk for severe side effects. To paraphrase Dr. Jerome Sullivan, cholesterol may load the gun, but it is iron that pulls the trigger. Possible association of a reduction in cardiovascular events with blood donation. (Meyers DG; Strickland D; Maloley PA; Seburg JK; Wilson JE; McManus BF) Heart, 1997 Aug, 78:2, 188-93 Iron versus cholesterol--perspectives on the iron and heart disease debate. (Sullivan JL) J Clin Epidemiol, 1996 Dec, 49:12, 1345-52 Iron and the sex difference in heart disease risk. (Sullivan JL) Lancet, 1981 Jun 13, 1:8233, 1293-4 High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men (Salonen JT; Nyyssnen K; Korpela H; Tuomilehto J; Sepp„nen R; Salonen R) Circulation, 1992 Sep, 86:3, 803-11 Dietary iron and coronary heart disease risk: a study from Greece. (Tzonou A; Lagiou P; Trichopoulou A; Tsoutsos V; Trichopoulos D) Am J Epidemiol, 1998 Jan, 147:2, 161-6 Body iron stores and the risk of carotid atherosclerosis: prospective results from the Bruneck Study (Kiechl S; Willeit J; Egger G; Poewe W; Oberhollenzer F) Circulation, 1997 Nov, 96:10, 3300-7 Body iron stores and the risk of coronary heart disease. (Sempos CT, Looker Anticoagulation, Gillum RF, et al) N Engl J of Med 330(16):1119-24, 1994. Lowering of body iron stores by blood letting and oxidation resistance of serum lipoproteins: A randomized cross-over trial in male smokers. (Salonen JT, Korpela H, Nyyssonen K, et al) J Intern Med 237(2):161-8, 1995.