For nearly four decades, those in medicine have been taught that cholesterol was the culprit in cardiovascular disease because it was found in atherosclerotic plaques.
Guilt by association was the primary justification for the decision back in the mid-fifties to force upon our nation the now infamous low fat / low cholesterol diet.
Now forty years later, the prevalence of atherosclerosis remains unchanged and we have become a nation of thoroughly fattened sheep with our present epidemic of gross obesity and type 2 diabetes. For forty years our doctors and their patients have been told that cholesterol was their enemy.
This entire fiasco was fueled by a scientist named Ancel Keys and his studies of the eating habits of people residing in Italy and surrounds and his belief that low dietary cholesterol was the secret of the supposed cardiovascular benefits of the Mediterranean diet.
So firmly did Keys believe his hypothesis that when some 14 of his 22 studies failed to support it, he disregarded them. When his data finally was presented to the Washington decision makers it was based solely upon the seven studies that agreed with his firmly entrenched philosophy and it became our national diet.
Now, longitudinal studies of statin drug use have revealed that cholesterol's role in cardiovascular disease risk is vanishingly small. I say vanishingly because, week- by-week research results are accumulating, pointing to cholesterol's irrelevancy. Inflammation is the cause of atherosclerosis, many now say.
Statin drugs exert their impressive effects because they are powerful anti-inflammatory agents, decreasing CV risk regardless of cholesterol's response. They do this through inhibition of Nuclear Factor kappa B (NF-kB), the essence of our entire immuno-defense system. Why then the continued focus on cholesterol?
Organized medicine is finally beginning to awaken to this reality and in fact has published some amazing truths. On 23 Sept, 2004 thirty-five prominent physicians, epidemiologist and other scientists wrote to the heads of the National Institutes of Health, the National Heart, Lung and Blood Institute and the National Cholesterol Education Program (NCEP) to urge an independent review of the scientific studies on which the new cholesterol guidelines were based. They charged complete lack of objectivity of the originators of these new guidelines because eight of the nine authors had direct financial ties to the pharmaceutical industry.
Signatories of this letter of objection included such medical dignitaries as John Abramson MD of Harvard, Jerome Hoffman MD of UCLA and David Brown MD of Albert Einstein and Beth Israel.
Their letter charged four major objections to the NCEP guidelines.
1) The evidence does not support extending the guidelines to women of moderate risk.
2) The evidence does not support extending the guidelines to older persons without heart disease
3) They claimed that extending the guidelines to diabetics without heart disease was unjustified by the evidence.
4) They observed that tripling the number of people on statins in accordance with the new NCEP directives provided no benefit to any patient, with or without heart disease.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor