Large study questions value of cutting cholesterol, especially for women

October 20, 1992|By Knight-Ridder News Service

In a departure from a decade of medical gospel, a new review of data from around the world questions assumptions about the value of reducing cholesterol, particularly for women. It has left experts on scientific quicksand.

The review -- the largest ever conducted -- has led some prominent researchers to call for a scaling back of widespread cholesterol-reduction programs. A few even suggest eliminating routine screening and treatment for many people now told to go on low-fat diets or take cholesterol-lowering drugs.

"It is a watershed paper," said Dr. Michael H. Criqui, epidemiologist at the University of California, San Diego, and an associate editor of Circulation, the journal that published the review article in its September issue. But, he added, "Some people don't want to talk about it. They think it is going to impede public health measures."

The study's most startling finding was in death rates among women:

Cholesterol levels in women appeared to have no influence on how often they died from all causes. High-cholesterol women died at the same rate as low-cholesterol women.

In men, the only groups with higher death rates than others were those whose cholesterol was either very high or very low. The death rate among men with borderline high cholesterol (200 to 239 milligrams of cholesterol per deciliter of blood) -- was about the same as the death rate among men with moderate levels of cholesterol (160 to 199).

This provocative picture has emerged as millions of people, heeding a decade of aggressive campaigning by the medical community, have turned to low-fat and "light" foods to lower their cholesterol levels.

It is not the first time researchers have turned up evidence questioning the benefits of lowering cholesterol. There have been some long-term skeptics of the national cholesterol-lowering campaign, but they were a small minority.

"This paper didn't make cholesterol controversial. It's been contro

versial for a long time," Dr. Criqui said.

The naysayers gained some credibility recently as studies linked very low cholesterol levels to higher rates of suicide, homicide and accidents. But only 12 percent of men and women fall into that very low range.

The report is a touchy subject among researchers but hardly one they can ignore. It is the most comprehensive look to date at the link between cholesterol and overall health, summarizing 19 studies of almost 650,000 men and women worldwide.

This raises troublesome questions about not only the National Cholesterol Education Program, a coalition of 38 medical groups formed in 1985 to educate the public about lowering cholesterol, but also the large industry that has grown up around cholesterol screening and cholesterol-lowering drugs. With at least one in every two U.S. adults being tested for cholesterol, the industry is estimated to be worth $20 billion a year.

The review paper pooled the results of studies of 523,737 men and 124,814 women in the United States, Japan, Europe and Israel. It included data from some of the largest and longest-running U.S. studies of cholesterol and health.

Some researchers find the new evidence so persuasive they think it is time, as one expert wrote in an editorial, "for a change in direction for cholesterol policy."

"We need now to pull back our national policies directed at identifying and treating high blood cholesterol," wrote Dr. Stephen Hulley of the University of California, San Francisco, referring to patients who do not yet have heart disease, "and put on hold well-meant desires to intervene while we await convincing evidence."

Dr. Hulley was one of the architects of the national program on cholesterol education when it was formed in the mid-1980s, but now he is one of a few who question it.

Trudy Bush, an epidemiologist at the Johns Hopkins University and an authority on women's heart disease, said she agreed that widespread cholesterol lowering could be "doing more harm than good."

But she stopped short of recommending that people completely abandon their low-fat diets.

"I still think we eat way too much fat in this country," Ms. Bush said.

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