Intended for healthcare professionals

Rapid response to:

Practice Practice Pointer

Managing dyslipidaemia for the primary prevention of cardiovascular disease

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k946 (Published 23 March 2018) Cite this as: BMJ 2018;360:k946

Rapid Response:

Re: Managing dyslipidaemia for the primary prevention of cardiovascular disease

time to challenge dysinformation about dyslipidaemia. http://bjsm.bmj.com/content/51/15/1111 increasing numbers of cardiologists and others question premise that cholesterol and lipids are cause of CVS disease, which in actual fact is caused more by inflammatory disease and metabolic syndrome. Low fat diet is escalating obesity with increase in sugar to make low fat foods palatable, and is particularly unhelpful in older population who are becoming deficient in fatty acids etc due to promotion of low fat diet. other consequences such as increase in vitamin D deficiency which is fat soluble vitamin. Cholesterol was only used in original studies as it was then the only lipid that could be measured and we now know that the substrate of LDL that drives CVS disease is linked to sugar in the diet and not fat. it is likely that the very marginal benefit of statins in primary prevention is due to stabilsing effect of statins and not to do with lipid levels at all. all the money spent on statins for primary prevention could be much better used on better nutritional advice, eg 5/2 diet or FASTDIET which treat metabolic syndrome, or improving the gut microbiome and effectively treating inflammatory disease, such as RA or IBD, and role of intensive exercise. patients are not convinced by NICE guidance and most GPs neither, and they are right to be skeptical, particularly as statins produce such common side effects which many cant tolerate.

Competing interests: No competing interests

23 March 2018
judith m neaves
GP and Musculoskeletal Physician and Osteopath
Lambrigg, tennement farm, burneside, kendal LA89AG