Re: keeping cholesterol low?

From: Juhana Harju (shantigiri_at_despammed.com)
Date: 01/11/05 

Date: Tue, 11 Jan 2005 12:17:39 +0200

Henriette Kress wrote:
> "Juhana Harju" <shantigiri@despammed.com> wrote:
>
>> the study below is probably the
>> largest study to show that there is an clear association between
>> cholesterol and coronary heart disease and total mortality.
>>
>> Martin MJ, Hulley SB, Browner WS, Kuller LH, Wentworth D. Serum
>> cholesterol, blood pressure, and mortality: implications from a
>> cohort of 361,662 men. Lancet. 1986 Oct 25;2(8513):933-6.
>
>> The risks associated with various levels of serum cholesterol were
>> determined by analysis of 6-year mortality in 361,662 men aged 35-57.
>> Above the 20th percentile for serum cholesterol (greater than 181
>> mg/dl, greater than 4.68 mmol/l), coronary heart disease (CHD)
>> mortality increased progressively; the relative risk was large (3.8)
>> in the men with cholesterol levels above the 85th percentile
>> (greater than 253 mg/dl, greater than 6.54 mmol/l). When men below
>> the 20th cholesterol percentile were used as the baseline risk
>> group, half of all CHD deaths were associated with raised serum
>> cholesterol concentrations; half of these excess deaths were in men
>> with cholesterol levels above the 85th percentile.
>
> So what they're saying is, half of the population gets heart trouble
> on less than high cholesterol. Hmm...

I was not saying that cholesterol is the only risk factor. I mentioned
several others also. :-)

>
> Also, what happens to these numbers if you factor out the single
> largest risk factor, namely, age?
>
>
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2877128
>>
>> The following study shows that having a good total cholesterol/HDL
>> ratio is more important than single levels of cholesterol.
>>
>> Natarajan S, Glick H, Criqui M, Horowitz D, Lipsitz SR, Kinosian B.
>> Cholesterol measures to identify and treat individuals at risk for
>> coronary heart disease. Am J Prev Med. 2003 Jul;25(1):50-7.
>
> That's more recent. Now, if you were to go even further into current
> research you'll see that cholesterol isn't predictive of heart
> trouble at all - what is predictive is C-reactive protein.

If you look at the most recent studies by Ridken and Nissen in the New
England Journal of Medicine (issue Jan 6, 2005) you'll find that
LDL-cholesterol and CRP are complementary markers and what is really
needed is the screening of *both*.

> A simple anti-inflammatory will help more than any statins. As will
> exercise and fish oils.

I also agree that most people should try lifestyle changes, like
exercise, weight reduction and dietary means, first.

>> The following study shows that the total cholesterol/HDL ratio is
>> also a good predictive tool among women.
>>
>> Shai I, Rimm EB, Hankinson SE, Curhan G, Manson JE, Rifai N, Stampfer
>> MJ, Ma J. Multivariate assessment of lipid parameters as predictors
>> of coronary heart disease among postmenopausal women: potential
>> implications for clinical guidelines. Circulation. 2004 Nov
>> 2;110(18):2824-30. Epub 2004 Oct 18. Department of Nutrition, Harvard
>> School of Public Health, Boston, MA 02115, USA.
>>
>> (P<0.0001). CONCLUSIONS: Lower levels of HDL-C may be a key
>> discriminator of higher CHD events among postmenopausal women.
>
> Giving only heart-related deaths is silly.
>
> That's like saying that the only death that matters is heart-related
> death. If that's indeed the case let's minimize that to 0 % - let's
> all jump off
> a tall cliff without a parachute. Those who report only heart-related
> disease in cholesterol med research should go first.
>
> No, show me the absolute total mortality numbers for that study. That
> would be relevant.

Unfortunately the whole article is restricted and I don't have access to
it -- do you? I agree that it would be relevant to know the total
mortality numbers also. But are you aware that in many fatal illnesses
the low cholesterol is caused by the devastating effect of the illness
and not the other way round? 

-- 
Juhana

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