New Cholesterol Guidelines for Converting Healthy People into Patients

[Guest guest]

http://www.cholesterol-and-health.com/Cholesterol-Guidelines.html

 

 

 

 

 

New Cholesterol Guidelines for Converting Healthy People into Patients

 

by Uffe Ravnskov, MD, PhD

 

(This article was originally published on Dr. Uffe Ravnskov's website

" The Cholesterol Myths, " and used with permission.)

 

In the May 16 issue (2001) of the Journal of the American Medical

Association an expert panel from the National Cholesterol Education

Program has published new guidelines for " the detection, evaluation,

and treatment of high blood cholesterol. " Their writing seems to be an

attempt to put most of mankind on cholesterol-lowering diets and

drugs. To do that, they have increased the number of risk factors that

demands preventive measures, and expanded the limits for the previous

ones.

 

But not only does the panel exaggerate the risk of coronary disease

and the relevance of high cholesterol, it also ignores a wealth of

contradictory evidence. The panel statements reveal that its members

have little clinical experience and lack basic knowledge of the

medical literature, or worse, they ignore or misquote all studies that

are contrary to their view.

 

Here come a few examples of the panel's false statements.

 

As an argument for using cholesterol-lowering drugs the panel claims

that twenty percent of patients with coronary heart disease have a new

heart attack after ten years. But to reach that number any minor

symptom without clinical significance is included.

 

Most people survive even a major heart attack, many with few or no

symptoms after recovery. What matters is how many die and this is much

less than twenty percent.

 

The panel also recommends cholesterol-lowering drugs to all diabetics

above 20, and to people with the metabolic syndrome. If you have at

least three of the " risk factors " mentioned below, you are suffering

from the metabolic syndrome:

 

Risk Factor

 

 

Limits according to the NCEP expert panel

 

Abdominal Obesity

 

 

Waist circumference above 88 cm in women;

 

Above 102 in men. Some male " patients "

 

Can develop many risk factors with a waist

 

Circumference of only 94 cm

 

High Triglycerides

 

 

150 mg/dL or more

 

Low HDL

 

 

Men less than 40 mg/dL

 

Women less than 50 mg/dL

 

High Blood Pressure

 

 

130/85 or higher

 

High Fasting Blood Sugar

 

 

110 mg/dL

 

 

 

 

 

 

Test yourself and your family! I guess that using these limits, most

of you " suffer " from the metabolic syndrome. And this new combination

of risk factors, says the panel, conveys a similar risk for future

heart disease as for people who already have coronary heart disease.

 

Luckily, it is not true.

 

It is not true either, that cholesterol has a strong power to predict

the risk of a heart attack in men above 65. In the 30 year follow-up

of the Framingham population for instance, high cholesterol was not

predictive at all after the age of forty-seven, and those whose

cholesterol went down had the highest risk of having a heart attack!

To cite the Framingham authors: " For each 1 mg/dl drop of cholesterol

there was an 11 % increase in coronary and total mortality (115). "

 

It is not true either, that high cholesterol is a strong, independent

predictor for other individuals.

 

In most studies of women and of patients who already have had a heart

attack, high cholesterol has little predictive power, if any at all.

 

In a large study of Canadian men high cholesterol did not predict a

heart attack, not even after 12 years, and in Russia, low, not high

cholesterol level, is associated with future heart attacks (read

summary of paper)

 

Most studies have shown that high cholesterol is a very weak risk

factor or no risk factor at all for old people; see for instance the

paper by Schatz et al., but there are many more. Considering that more

than 90% of all cardiovascular deaths occur in people above 60, this

fact should have stopped the cholesterol campaign years ago.

 

Also interesting is the fact, that in some families with the highest

cholesterol levels ever seen in human beings, so-called familial

hypercholesterolemia, the individuals do not get a heart attack more

often than ordinary people, and they live just as long (read and my

comment).

 

Taken together such observations strongly suggest that high

cholesterol is only a risk marker, a factor that is secondary to the

real cause of coronary heart disease. It is just as logical to lower

cholesterol to prevent a heart attack, as to lower an elevated body

temperature to combat an underlying infection or cancer.

 

It has also escaped the panel's attention that the effect of the new

cholesterol-lowering drugs, the statins, goes beyond a lowering of

cholesterol. The question is whether their cholesterol-lowering effect

has any importance at all because the statins exert their effect

whether cholesterol goes down a little or whether it goes down very much.

 

No doubt, the statins lower the risk of dying from a heart attack, at

least in patients who already have had one, but the size of the effect

is unimpressive. In one of the experiments for instance, the CARE

trial, the odds of escaping death from a heart attack in five years

for a patient with manifest heart disease was 94.3 %, which improved

to 95.4 % with statin treatment

 

For healthy people with high cholesterol the effect is even smaller.

The WOSCOPS trial studied that category of people and here the figures

were 98.4 % and 98.8 %, respectively.

 

In the scientific papers and in the drug advertisements these small

effects are translated to relative effect. In the mentioned WOSCOPS

trial for instance, it is said that the mortality was lowered by 25 %,

because the difference between a mortality of 1.6 % in the control

group and 1.2 % in the treatment group is 25 %.

 

When presented with accurate statistics on the value of statins,

almost all my patients have rejected such treatment. To claim that the

statins dramatically reduce a persons risk for CHD, as was stated in

the press by Claude Lenfant, the director of the National Heart, Lung

and Blood Institute, is a misuse of the English language.

 

The figures above do not take into account possible side effects of

the treatment. In most animal experiments the statins, as well as most

other cholesterol-lowering drugs, produce cancer (90), and they may do

it in human beings also.

 

In one of the statin trials there were 13 cases of breast cancer in

the group treated vid pravastatin (Pravachol®), but only one case in

the untreated control group, a scaring fact that is never mentioned in

the advertisements or the guidelines.

 

It is also an alarming fact that in one of the largest experiments,

the EXCEL trial, total mortality after just one year's treatment with

lovastatin (Mevacor®) was significantly higher among those receiving

statin treatment. Unfortunately (or happily?) the trial was stopped

before further observations could be made.

 

In human beings the effects of cancer-producing chemicals are not seen

before the passage of decades. If the statins produce cancer in human

beings, their small positive effect may eventually be transformed to a

much larger negative one, because side effects usually appear in much

higher percentages than the small positive ones noted in the trials.

 

Whereas possible serious side effects of the statins are hypothetical,

those from the previous cholesterol-lowering drugs, still recommended

by the panel, are real. Taking all experiments together, mortality

from heart disease after treatment with these drugs was unchanged and

total mortality increased, a fact that has given researchers outside

the National Cholesterol Education Program and the American Heart

Association much reason for concern.

 

The panel's dietary recommendations represent the seventh major change

since 1961. For instance, the original advice from the American Heart

Association to eat as much polyunsaturated fat as possible has been

reduced successively to the present " up to ten per cent " .

 

But why this limit? Seven years ago the main author of the new

guidelines, Professor Scott Grundy, suggested an upper limit of only

seven per cent, because, as he argued, an excess of polyunsaturated

fat is toxic to the immune system and stimulates cancer growth in

experimental animals and may also provoke gall stones in human beings.

These warnings have never reached the public.

 

Furthermore, the panel ignores that a recent systematic review of all

studies concerning the link between dietary fat and heart disease

found no evidence that a manipulation of dietary fat has any effect on

the development of atherosclerosis or cardiovascular disease (read

summary of the paper - this paper won the Skrabanek Award 1998).

 

For instance, in a large number of studies, including the incredible

number of more than 150,000 individuals, none of them found the

predicted pattern of dietary fats in patients with heart disease.

 

No supportive association has been found either between the fat

consumption pattern and the degree of atherosclerosis

(arteriosclerosis) after death.

 

Most important, the mortality from heart disease and from all causes

was unchanged in nine trials with more radical changes of dietary fat

than ever suggested by the National Cholesterol Education Program, a

result that was confirmed recently in another review (read the paper

and my comment).

 

To suggest that diabetic patients should obtain more than 50 percent

of their caloric intake from carbohydrates seems unusually bad advice.

Many carbohydrates are quickly transformed into sugar inducing rapid

changes in blood sugar and insulin levels and thus stimulating a rapid

conversion of blood sugar to depot fat and chronic feelings of hunger.

Diabetic patients should eat more fat.

 

Is it a coincidence that the Americans' decreasing intake of fat

during the last decade has been followed by a steady increase of their

mean body weight and an epidemic increase of diabetes?

 

Instead of preventing cardiovascular disease the new guidelines may

increase the mortality of other diseases, transform healthy

individuals into unhappy hypochondriacs obsessed with the chemical

composition of their food and their blood, reduce the income of

producers of animal fat, undermine the art of cuisine, destroy the joy

of eating, and divert health care money from the sick and the poor to

the rich and the healthy. The only winners are the drug and imitation

food industry and the researchers that they support.

 

Uffe Ravnskov

MD, PhD, independent researcher Spokesman for THINCS, The

International Network of Cholesterol Skeptics A short edition of the

above was sent to the editor of JAMA. Read his answer.

If you lack the scientific evidence of something written above you

will find it in The Cholesterol Myths.

Feel free to publish this article anywhere, but don't forget to tell

from where it comes (follow this link).

 

Published June 2, 2001; latest revision Oct 31, 2003

 

Back to Home Search This Site