New cholesterol guidelines for converting healthy people into patients

[Guest guest]

Reprinted from:

http://www.ravnskov.nu/ncep_guidelines.htm

New cholesterol guidelines for converting healthy people into patients

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Uffe Ravnskov, MD, PhD

(Feel free to publish this site anywhere, but don´t forget to tell from

where it comes)

In the May 16 issue 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 " (read the paper). 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 or higher

Test yourself and your family! I guess that most of you " suffer " from the

metabolic syndrome. And this combination, 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 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 the paper 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 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

Uffe Ravnskov, MD, PhD

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

If you lack the scientific evidence for something written above you will

find it in my book, The Cholesterol Myths. Exposing the fallacy that

saturated fat and cholesterol cause heart disease.

Extracts from the book are presented on my website:

The Cholesterol Myths

Feel free to publish this site anywhere, but don't forget to tell where it

comes from

Published June 2, 2001; latest revision June 11, 2001

Reprinted from:

http://www.ravnskov.nu/ncep_guidelines.htm

[Guest guest]

If cholesterol causes coronary heart disease and cancer, it should be easy to

prove. Virtually all oils and fats used for culinary purposes prior to the 1920s

were derived from animal sources, the major exceptions being olive, coconut and

palm kernel oils, the latter two of which are also high in cholesterol. If

cholesterol actually does caus CHD and cancer, medical records from the late

19th and early 20th century should show epidemic levels of of these diseases.

The fact is that they were EXTREMELY RARE. With the introduction of new

technology in the 1920s that allowed oil to be extracted from seeds that do not

easily give up their oil (corn for example), cases of CHD and cancer levels

began to accelerate, culminating in the epidemic levels of these diseases today.

The process of hydrogenation was also invented about the same time. Procter &

Gamble introduced their Crisco brand of hydrogenated cottonseed oil to the

market in 1922.

No only does historical data fail to prove the Lipid Hypothesis, it totally

demolishes it! The large corporations that push the Lipid Hypothesis certainly

don't let facts stand in their way when it comes to propaganda that sells their

frankenoils though. Although the Framingham study which the Ravnskov article

mentions also demolished it, the government and manufacturers just put their own

spin on the study, claiming that it proved the hypothesis. Sounds like something

out of Alice in Wanderland! (Tweedle Dum and Tweedle Dee?)

>Reprinted from:

>http://www.ravnskov.nu/ncep_guidelines.htm

>

>New cholesterol guidelines for converting healthy people into patients

>

[snip]

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Neil Jensen: neil@...

The WWW VL: Sumeria http://www.sumeria.net/

Why would someone pay $1.89 for a bottle of Evian water?

(hint: Try spelling " Evian " backwards!)

[Guest guest]

Uffe Ravnskov, MD, PhD was quoted as declaring:

>A short edition of the above was sent to the editor of JAMA. Read

>his answer.

I'd love to read the JAMA editor's answer. Where is it? It was not

included in the posting.

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IRA L. JACOBSON

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