New guidelines for converting healthy people into patients

28 May 2001

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.

Competing interests: None declared

Uffe Ravnskov, None

Magle Stora Kyrkogata 9, S-22350, Lund

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