CONCLUSIONS What we are seeing is that over the years there has been a steady flow of problems and “how come” questions that eat away at the credibility of the cholesterol hypothesis. The resolution of all of these problems is simple— most features of the hypothesis are false. Rephrasing the hypothesis such that it only states that atherosclerosis and CHD are associated with cholesterol levels removes what is considered an incorrect attempt to connect observational studies with causality, but the evidence presented above also argues equally well against there being, for the most part, any such association.
In a second Review related to the Cholesterol Hypothesis, we will look in much more detail at the association between TC and LDL levels and overall and CHD mortality. A third Review will deal with cholesterol lowering studies, the current popular notion that the lower the better for LDL, the so-called Polypill proposal, and the question of cholesterol and stroke risk and stroke mortality.
Miida T, Takahashi A, Ikeuchi T, 2007. Prevention of stroke and dementia by statin therapy: experimental and clinical evidence of their pleiotropic effects. Pharmacol.Ther. 113(2):378-393.
Liao JK, 2002. Beyond lipid lowering: the role of statins in vascular protection. Int.J Cardiol. 86(1):5-18.
Kendrick M, The Great Cholesterol Con. The Truth About What Really Causes Heart Disease and How to Avoid It. John Blake Publishing Ltd., London, U.K., 2007.
Lande K, Sperry W, 1936. Human Atherosclerosis in Relation to the Cholesterol Content of the Blood Serum. Archives of Pathology. 22:301-312.
Paterson J, Armstrong R, Armstrong E, 1963. Serum lipid levels and the severity of coronary and cerebral atherosclerosis in adequately nourished men. Circulation. 27:229-236.
Mathur KS et al., 1961. Serum cholesterol and atherosclerosis in man. Circulation. 23:847-852.
Ravnskov U, 2002. Is atherosclerosis caused by high cholesterol? QJM. 95(6):397-403.
Ravnskov U, The Cholesterol Myths. Exposing the Fallacy that Saturated Fat and Cholesterol Cause Heart Disease. NewTrends Publishing, Inc, Washington, D.C., 2000.
Kondos GT et al., 2003. Electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5635 initially asymptomatic low- to intermediate-risk adults. Circulation. 107(20):2571-2576.
Allison MA, Wright CM, 2005. Age and gender are the strongest clinical correlates of prevalent coronary calcification (R1). Int.J Cardiol. 98(2):325-330.
Oei HH et al., 2004. Risk factors for coronary calcification in older subjects. The Rotterdam Coronary Calcification Study. Eur.Heart J. 25(1):48-55.
Sekikawa A et al., 2005. Much lower prevalence of coronary calcium detected by electron-beam computed tomography among men aged 40-49 in Japan than in the US, despite a less favorable profile of major risk factors. Int.J Epidemiol. 34(1):173-179.
Nasir K et al., 2006. Relationship of subclinical coronary atherosclerosis and National Cholesterol Education Panel guidelines in asymptomatic Brazilian men. Int.J Cardiol. 108(1):68-75.
Aiyer AN et al., 2007. Racial differences in coronary artery calcification are not attributed to differences in lipoprotein particle sizes: the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) Study. Am.Heart J. 153(2):328-
Hoff JA et al., 2003. Conventional coronary artery disease risk factors and coronary artery calcium detected by electron beam tomography in 30,908 healthy individuals. Ann Epidemiol. 13(3):163-169.
Arad Y et al., 2005. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am.Coll.Cardiol. 46(1):158-165.
Hecht HS et al., 2001. Relation of coronary artery calcium identified by electron beam tomography to serum lipoprotein levels and implications for treatment. Am J Cardiol. 87(4):406-412.
Kronmal RA et al., 2007. Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 115(21):2722-2730.
Ravnskov U, 2003. High cholesterol may protect against infections and atherosclerosis. QJM. 96(12):927-934.
Marmot MG et al., 1975. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of coronary and hypertensive heart disease and associated risk factors. Am.J Epidemiol. 102(6):514-525.
Marmot MG, Syme SL, 1976. Acculturation and coronary heart disease in Japanese-Americans. Am.J Epidemiol. 104(3):225-247.
Anderson KM, Castelli WP, Levy D, 1987. Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA. 257(16):2176-2180.
Allison MA, Wright CM, 2005. Age and gender are the strongest clinical correlates of prevalent coronary
calcification (R1). Int.J Cardiol. 98(2):325-330.
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