In a competition for being the commonest non-disease in the world, no
one can stand comparison with hypercholesterolaemia. Together with its
many cousins in the lipid family, it includes at least a third of the
Western population, if not more (1).
Non-disease is rarely met by non-treatment. Unfortunately so, because
not a single life has been saved by the boring diets and the toxic drugs
that have been used since many years in millions of people (2). The new
cholesterol lowering drugs, the statins have saved some, but the number is
small in comparison with the number of treated non-patients. That the
statins do benefit is taken as proof that hypercholesterolaemia is a
disease although all evidence has shown that the statins do not operate
through cholesterol lowering. Indeed, statins may benefit, not because of,
but in spite of their cholesterol lowering, because high cholesterol may
protect against disease. This was the conclusion from the finding of a
lower than normal coronary and total mortality seen in several pedigrees
of individuals with familial hypercholesterolaemia (3). The sad paradox is
that by treating non-diseases we may create real ones.
1. Executive Summary of the third report of the National Cholesterol
Education Program (NCEP)expert panel on detection,evaluation, and
treatment of high blood cholesterol in adults (adult treatment panel III).
JAMA 2001; 285: 2486-97.
2. Ravnskov U. The cholesterol myths. Washington DC: New Trends
Publishing; 2000.
3. Sijbrands EJG, Westendorp J, Defesche JC, de Meier PHEM, Smelt AHM,
Kastelein JP. Mortality over two centuries in large pedigree with familial
hypercholesterolaemia: family tree mortality study. BMJ 2001; 322: 1019-
23.
Rapid Response:
Hypercholesterolaemia - the superior winner
In a competition for being the commonest non-disease in the world, no
one can stand comparison with hypercholesterolaemia. Together with its
many cousins in the lipid family, it includes at least a third of the
Western population, if not more (1).
Non-disease is rarely met by non-treatment. Unfortunately so, because
not a single life has been saved by the boring diets and the toxic drugs
that have been used since many years in millions of people (2). The new
cholesterol lowering drugs, the statins have saved some, but the number is
small in comparison with the number of treated non-patients. That the
statins do benefit is taken as proof that hypercholesterolaemia is a
disease although all evidence has shown that the statins do not operate
through cholesterol lowering. Indeed, statins may benefit, not because of,
but in spite of their cholesterol lowering, because high cholesterol may
protect against disease. This was the conclusion from the finding of a
lower than normal coronary and total mortality seen in several pedigrees
of individuals with familial hypercholesterolaemia (3). The sad paradox is
that by treating non-diseases we may create real ones.
1. Executive Summary of the third report of the National Cholesterol
Education Program (NCEP)expert panel on detection,evaluation, and
treatment of high blood cholesterol in adults (adult treatment panel III).
JAMA 2001; 285: 2486-97.
2. Ravnskov U. The cholesterol myths. Washington DC: New Trends
Publishing; 2000.
3. Sijbrands EJG, Westendorp J, Defesche JC, de Meier PHEM, Smelt AHM,
Kastelein JP. Mortality over two centuries in large pedigree with familial
hypercholesterolaemia: family tree mortality study. BMJ 2001; 322: 1019-
23.
Competing interests: No competing interests