Health

The big fat debate on cholesterol and statins | Letters


Those who advocate a low-fat diet to reduce cholesterol (Heart breakers, G2, 30 October) have had 50 years to test their hypotheses and the results are devastating: a worldwide obesity crisis, and a plethora of chronic disease, despite people’s efforts to follow the advice. The results of the PURE study based on 18 countries across five continents were clear: “High total carbohydrate intake was associated with higher total mortality whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction or cardiovascular disease mortality, whereas saturated fat had an inverse relationship with stroke” (The Lancet, November 2017).

Nina Teicholz’s book The Big Fat Surprise provides a thoroughly researched analysis of how we got to this point. Hundreds of thousands of people are conducting their own science experiments in testing the low-carbohydrate diet together with intermittent fasting and finding they work. As well as losing huge amounts of body fat, reversing or reducing their medication for type 2 diabetes, their blood markers also improve. The necessity for statins depends on the theory that high cholesterol is the cause of heart disease. The levels of cholesterol requiring treatment have been progressively lowered so that many millions of people are now advised to take statins. There is evidently a financial incentive for pharmaceutical companies to continue and extend their use.
Sue Morgan
Winchester

The evidence that raised lipids (chiefly cholesterol) in the blood are linked to an increased risk of heart disease has long been established. More recently, conclusive evidence that lowering the level of these lipids, mainly by drugs, has emerged. While these trials have been sponsored by drug companies with vested interests (no one else will fund them), they have been performed to very high standards by people with great experience and integrity, and rigorously debated. It has been proven beyond reasonable doubt that lowering blood lipid levels, by statins, significantly reduces a person’s risk of heart disease.

The situation with diet and dietary intake of fat is different. Here the evidence is at best observational and mainly anecdotal, thus far less rigorous than for treating blood lipids. The evidence for special diets such as the Pioppi or Atkins diets is very weak. But there is strong evidence that obesity is linked to heart disease, and preventing or reversing it will lower rates of heart disease.

Patients can be confident that having their blood lipids reduced by drugs is a safe and efficacious way of reducing their risk of heart disease. Obesity should be avoided or dealt with – a complex topic in itself. There is no reason to take up specialised diets as they are unproven.
Maurice Buchalter
Consultant cardiologist, Penarth

The National Institute for Health and Care Excellence recommends statins for those with a 10% chance of a heart attack in the next 10 years. Examine this in detail: 100 people at 10 % risk of heart attack or stroke over 10 years means that at the end of 10 years 90 of those people will not have had a heart attack or stroke and 10 of those people will have had such an event. If all of those 100 people take a statin for 10 years their risk is reduced by about a third. This means that after 10 years of statins, instead of 90 people remaining free of heart attacks, 93 will avoid one, seven people will have heart attacks even if they take statins for the whole 10 years, while three lucky people who would have had a heart attack avoid one. We do not know how to identify those three who benefit the most.

This means 97 people have to take pills for 10 years in order that three people benefit. The big problem with statins is not whether they benefit those at very high risk (they do), but the uncritical mass medication of people at low risk, 97% of whom will get no benefit at all. Those who do not benefit are nonetheless exposed to potential side effects, which include an increase in the rate of diabetes. What drives these recommendations for medicating large numbers of people for the benefit of very few?
Avril Danczak
Manchester

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

Do you have a photo you’d like to share with Guardian readers? Click here to upload it and we’ll publish the best submissions in the letters spread of our print edition



READ SOURCE

Leave a Reply

This website uses cookies. By continuing to use this site, you accept our use of cookies.