Re: The Great "Mediterranean Diet" Fraud.

From: Juhana Harju (shantigiri_at_despammed.com)
Date: 03/27/05 

Date: Sun, 27 Mar 2005 14:48:51 +0300

Rob Capps wrote:

:: Now, as to tot chol:HDL, I'd like to reframe your question before
:: answering it. Here goes:
::
:: Is the ratio of total cholesterol to HDL the BEST predictor of CHD?
::
:: To THIS question, I can answer an unequivocal "No."
::
:: You see, the structure of your original question made it impossible
:: to issue a denial, but also made it impossible to give a meaningful
:: answer. You could just as easily have asked if I deny the predictive
:: value of homocysteine, male pattern baldness, or even creased
:: earlobes. I cannot deny that all of these are nominally predictive,
:: but that doesn't mean I'm going to endorse their routine clinical
:: use.
::
:: So, back to my preferred question and answer. The practice of
:: evidence-based medicine requires the selection of tests with the
:: strongest predictive value AND the lowest cost. If something worked
:: better than cholesterol but was horrendously expensive, I couldn't
:: conscientously support its use. But if that something worked better
:: AND was relatively cheap...is there such a beast?
::
:: Yup.
::
:: In the past few years, the chronic inflammatory theory of CAD
:: etiology has been gaining support. And the utility of acute phase
:: reactant assays - especially C-reactive protein - in predicting the
:: onset of disease has been repeatedly demonstrated. More importantly,
:: serum hsCRP has beaten ANY subfractional combination of cholesterol
:: you care to name, in recent studies of considerable statistical
:: power. As to cost, both run less than $50 (US). hsCRP is currently
:: more expensive, but labs typically lower their prices when the
:: volume goes up, and hsCRP isn't ordered NEARLY as often as FLP.
::
:: Researchers whose careers have been built on the cholesterol issue
:: (especially those on the payroll of Big Pharma), are amusing in their
:: attempts to equivocate, but I'm betting that by the time I finish my
:: residency or shortly thereafter - say 5 years - hsCRP will be within
:: the acceptable standard of care. Maybe within 20 the NCEP will be
:: nothing more than an historical footnote. Otherwise, I'll have to
:: explain myself over and over and over...
::
:: Have I explained myself to YOUR satisfaction? :)

I do agree with the inflammation theory in the ethiology of CAD and I
agree that hsCRP has good predictive value. However, I would like to see
references that would show that hsCRP is unequivocally better predictor
of CAD than TC:HDL ratio. So, references to back your claim, please. :-)
Based on the studies and abstracts I have read I would say that TC:HDL
ratio and hsCRP are equal in predicting CAD and combining them would
give the best results. Measuring homocysteine also would further add the
predictive power. I think that CAD is a multifacetial disease and can
not be explained or predicted by one factor only. 

-- 
Juhana

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