Intended for healthcare professionals

Rapid response to:


Cholesterol lowering margarine launched in United Kingdom

BMJ 1999; 318 doi: (Published 10 April 1999) Cite this as: BMJ 1999;318:960

Rapid Response:

Questionable effects of cholesterol lowering by dietary changes

Benecol may possibly lower serum cholesterol, but a high cholesterol
is not a disease. It is highly unlikely that Benecol prevents coronary
heart disease just because it lowers the cholesterol concentration as the
combined results from eight ecological, four dynamic population, 41 cross-
sectional, 25 cohort, and six case-control studies as well as a meta-
analysis of nine, controlled, randomised trials strongly contradict an
influence of dietary saturated and polyunsaturated fats on atherosclerosis
or coronary heart disease (1).
That the serum cholesterol concentration was unchanged at follow-up in the
only successful dietary trial (2) is in accord with the observation from
the statin-trials (3), as well as from the previous cholesterol lowering
trials (4), that any treatment effect is independent on the degree of
cholesterol lowering. Lack of dose-response is a strong argument against
causality indicating that a high serum cholesterol is only a risk marker
which is secondary to other, more important factors; it therefore seems
without meaning to exchange nutritious and palatable natural fats with a
chemical product with unknown long-term effects.
Besides, the decrease of coronary mortality seen in North Karelia was not
due to the Karelia project because mortality decreased also in the rest of
Finland, where no health education was given (5).
Uffe Ravnskov

1. Ravnskov U. The questionable role of saturated and polyunsaturated
fatty acids in cardiovascular disease. J Clin Epidemiol. 1998;51:443-60

2. de Lorgeril M, Renaud S, Mamelle N, Salen P, Martin JL, Monjaud I, et
al. Mediterranean alpha-linolenic acid-rich diet in secondary prevention
of coronary heart disease. Lancet 1994;343:1454-9

3. Sacks FM, Moyé LA, Davis BR, Cole TG, Rouleau JL, Nash DT et al.
Relationship between plasma LDL concentrations during treatment with
pravastatin and recurrent coronary events in the cholesterol and recurrent
events trial. Circulation 1998;97:1446-52.

4. Ravnskov U. Cholesterol lowering trials in coronary heart disease:
frequency of citation and outcome. BMJ 1992;305:15-9

5. Oliver MF. North Karelia project. Lancet 1987;2:517-8.

Competing interests: No competing interests

15 April 1999
Uffe Ravnskov
private practitioner; independent researcher
RÕbygatan 2, S-22361 Lund, Sweden