Intended for healthcare professionals

Letters Hypercholesterolaemia

Should medical science ignore the past?

BMJ 2008; 337 doi: (Published 16 September 2008) Cite this as: BMJ 2008;337:a1681
  1. Uffe Ravnskov, independent researcher1
  1. 1Magle Stora Kyrkogata 9, 22350 Lund, Sweden
  1. ravnskov{at}

    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


    • Competing interests: None declared.


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