BMJ 1994;308:1104-1105 (23 April)

Letters

Ischaemic heart disease and cholesterol Safety of cholesterol reduction remains in doubt

EDITOR, - At their core the papers by M R Law and colleagues are about the advisability of reducing the cholesterol concentration in the general population, principally through restriction of dietary fat.*RF 1-3* This primary prevention mandate is plagued by controversies, while consensus exists for lowering cholesterol in patients with coronary heart disease. What, then, do the papers add to the issues surrounding population based dietary treatment to lower serum cholesterol concentrations?

With respect to evidence that a low cholesterol concentration is associated with increased mortality from causes other than coronary heart disease Law and colleagues emphasise that these relations are seen exclusively in community based populations rather than in (typically smaller) cohorts based on occupation. They assert that illness present at entry to community based studies caused a fall in cholesterol concentrations. The authors fail to recognise, however, that the largest "community based" cohort was in fact recruited primarily . . . [Full text of this article]


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Relevant Article

Systematic underestimation of association between serum cholesterol concentration and ischaemic heart disease in observational studies: data from the BUPA study
M R Law, N J Wald, T Wu, A Hackshaw, and A Bailey
BMJ 1994 308: 363-366. [Abstract] [Full Text]

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