New cholesterol guidelines for converting healthy people into patients


    Uffe Ravnskov, MD, PhD 

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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


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 using these limits, most of you "suffer" from the metabolic syndrome. And this new combination of risk factors, 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). 


For the rest of the article click on this link --

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