Lopez expresses surprise in his editorial that tobacco causes less
deaths from vascular disease in China than in western countries.[1] Yet
this is to be expected because China has a lower level of milk consumption
and a lower prevalence of adult lactose absorbers,[2] which are similarly
associated with lower mortality from ischaemic heart disease (IHD) in
other populations than can be expected from tobacco and other conventional
risk factors: Japanese, some Polynesians and Melanesians, South African
Blacks, Mediterranean Europeans, Afro-Caribbeans in
Britain, and Greenland Eskimos.[3,4] These two global clues on a possible
protection from IHD (i.e. reducing intake of lactose) have not been
followed up by cardiovascular epidemiologists and scientists. WHO should
therefore accept the responsibility to institute appropriate
investigations on this hypothesis.
1. Lopez AD. Counting the dead in China. BMJ 1998;317:1399-40.
2. Segall JJ. Hypothesis: Is lactose a dietary risk factor for ischaemic
heart disease? Int J Epidemiol 1980;9:271-76.
3. Segall JJ. Dietary lactose as a possible risk factor for
ischaemic heart disease: review of epidemiology. Int J Cardiol 1994;46:197
-207.
4. Segall JJ. Epidemiological evidence for the link between
dietary lactose and atherosclerosis (chapter 10). In: Colaco CALS, ed. The
glycation hypothesis of atherosclerosis. Austin, TX: Landes Bioscience,
1997.
JEFFREY J. SEGALL MBBS, MRCP 24 NOVEMBER 1998
General practitioner (Retired)
308 Cricklewood Lane
London NW2 2PX, UK
Rapid Response:
Consumption of milk is lower in China
Lopez expresses surprise in his editorial that tobacco causes less
deaths from vascular disease in China than in western countries.[1] Yet
this is to be expected because China has a lower level of milk consumption
and a lower prevalence of adult lactose absorbers,[2] which are similarly
associated with lower mortality from ischaemic heart disease (IHD) in
other populations than can be expected from tobacco and other conventional
risk factors: Japanese, some Polynesians and Melanesians, South African
Blacks, Mediterranean Europeans, Afro-Caribbeans in
Britain, and Greenland Eskimos.[3,4] These two global clues on a possible
protection from IHD (i.e. reducing intake of lactose) have not been
followed up by cardiovascular epidemiologists and scientists. WHO should
therefore accept the responsibility to institute appropriate
investigations on this hypothesis.
1. Lopez AD. Counting the dead in China. BMJ 1998;317:1399-40.
2. Segall JJ. Hypothesis: Is lactose a dietary risk factor for ischaemic
heart disease? Int J Epidemiol 1980;9:271-76.
3. Segall JJ. Dietary lactose as a possible risk factor for
ischaemic heart disease: review of epidemiology. Int J Cardiol 1994;46:197
-207.
4. Segall JJ. Epidemiological evidence for the link between
dietary lactose and atherosclerosis (chapter 10). In: Colaco CALS, ed. The
glycation hypothesis of atherosclerosis. Austin, TX: Landes Bioscience,
1997.
JEFFREY J. SEGALL MBBS, MRCP 24 NOVEMBER 1998
General practitioner (Retired)
308 Cricklewood Lane
London NW2 2PX, UK
Tel/Fax: 0181-455 5005
Competing interests: No competing interests