High levels of bad cholesterol in early middle age are linked to CVD risk decades later, study findsBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6814 (Published 04 December 2019) Cite this as: BMJ 2019;367:l6814
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The Inflammation and Heart Disease Theory does not exclude LDL-cholesterol. Re: High levels of bad cholesterol in early middle age are linked to CVD risk decades later, study finds
In the mid-1990s, the first author – as an American Heart Association (AHA) Lipid Reviewer - introduced The Inflammation and Heart Disease Theory [1,2] at a series of AHA conferences, which were further detailed and published in 1999 [3-5].
At the time cholesterol was viewed as the cause of coronary artery disease (CAD) and little was understood about the role of inflammation. Research at that time focused on adding hormone therapy to both men and women in an effort to reduce CAD; a treatment based upon an assumption of benefit, which turned out to be detrimental [6-12].
The inflammation theory received little attention until early 2004 when it was presented on 20/20 [13,14]. The complete inflammation and heart disease theory includes a number of variables, each of which must be considered and each of which interact differently in different individuals, based upon specific environmental and genetic conditions .
While it is easy to over simply the theory and exclude LDL cholesterol and saturated fat from the discussion on inflammation [16,17], it is dangerous to do so as it misleads individuals into a sense of je ne sais quoi. LDL cholesterol and saturated fat are very much a part of the Inflammation and Heart Disease Theory .
1. Fleming RM. Arteriosclerosis as Defined by Quantitative Coronary Arteriography. The Council on Arteriosclerosis for the 67th Scientific Sessions of the AHA. November 1994:102.
2. Fleming RM, Ketchum K, Fleming D, Gaede R. Controlling Hypercholesterolemia by Diet and Drug Therapy in the Elderly. 1st Annual Scientific Session on Cardiovascular Disease in the Elderly, March 18, 1995, New Orleans, LA.
3. Fleming RM. Chapter 29. Atherosclerosis: Understanding the relationship between coronary artery disease and stenosis flow reserve. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999. pp. 381-387.
4. Fleming RM. Chapter 30. Cholesterol, Triglycerides and the treatment of hyperlipidemias. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999, pp. 388-396.
5. Fleming RM. Chapter 64. The Pathogenesis of Vascular Disease. Textbook of Angiology. John C. Chang Editor, Springer-Verlag New York, NY. 1999, pp. 787-798.
6. Catakoglu AB, Kendirci M. Testosterone replacement therapy and cardiovascular events. Turk Kardiyol Dem Ars 2017;45(7):664-672.
7. Kloner RA, Carson C, Dobs A, Kopecky S, Mohler ER. Testosterone and Cardiovascular Disease. JACC 2016;67(5):545-557.
8. Fleming RM. Are there differences in breast tissue as a result of hormone replacement therapy? Can BEST imaging distinguish these differences? Integrative Cancer Therapies 2003;2:229-34.
9. Fleming RM. Do women taking hormone replacement therapy (HRT) have a higher incidence of breast cancer than women who do not? Integrative Cancer Therapies 2003;2:235-237.
10. Writing group for the women’s health initiative investigators. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. JAMA 2002;288(3):321-333.
11. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA 1998;280(7):605-613.
12. Manson JE, Hsia J, Johnson KC, et al. Estrogen plus Progestin and the Risk of Coronary Heart Disease. N Engl J Med 2003;349:523-534.
13. Fleming RM. Stop Inflammation Now! with Tom Monte. Published by Putnam Books and Avery Books. December 2003. ISBN: 0399151117
14. 20/20 Segment on Inflammation and Heart Disease. https://www.youtube.com/watch?v=Hvb_Ced7KyA&t=22s
15. Fleming RM, Fleming MR, Chaudhuri TK. The Similarities in Coronary Artery Disease and Cancer. Acta Scientific Med Sci. 2019;Special Issue 1:03-04. DOI:10.31080/ASMS.2019.S01.0002.
16. Malhotra A, Apps A, Saini V, Gray M. Right care and high-value cardiology: doctors’ responsibilities to the patient and the population. Postgraduate Medical Journal 2015;91:415-417.
17. Malhotra A, Redberg RF, Meier P. Saturated fat does not clog the arteries: coronary heart disease is a chronic inflammatory condition, the risk of which can be effectively reduced from healthy lifestyle interventions. Br J Sports Med 2017;51(15):1111-1112.
Competing interests: The Inflammation and Heart Disease Theory was created by first author.