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Sugar not saturated fat is the major issue for CVD

Lowering serum cholesterol with statins ‘dubious at best’, eat ‘real food’ instead

Louise Prime

Wednesday, 23 October 2013

It is time to “bust the myth” of the role of saturated fat in cardiovascular risk, a cardiologist has urged today on bmj.com. He goes on to question both the sanctity of the idea that total serum cholesterol is a risk factor for coronary artery disease, and what benefit has followed the huge increase in the prescription of statins.

Aseem Malhotra, from Croydon University Hospital in London, observes that the demonisation of saturated fat began in 1970 “when the landmark ‘seven countries’ study … concluded that a correlation existed between the incidence of coronary heart disease and total cholesterol concentrations, which then correlated with the proportion of energy provided by saturated fat”. He points out that it was after producers started to add large amounts of sugar to food, to make up for the loss of flavour when they cut the fat content, that obesity rates really rocketed.

But, he points out, the evidence now shows that saturated fat is actually protective against cardiovascular disease, and increasingly supports the idea that sugar is a possible independent risk factor for metabolic syndrome.

Dr Malhotra questions why – when three-quarters of people admitted with acute myocardial infarction have completely normal total cholesterol levels but two-thirds have metabolic syndrome, and research shows that that high total cholesterol is not a risk factor in a healthy population – the number of people prescribed statins in the UK has risen from five million to eight million over the past decade. He also points out that the rates of important adverse effects reported in people taking statins in the real world has been “massively” higher than those reported in the major statin trials.

Dr Malhotra claims that “the government’s obsession with levels of total cholesterol, which has led to the overmedication of millions of people with statins, has diverted our attention from the more egregious risk factor of atherogenic dyslipidaemia”.

He writes that adopting a Mediterranean diet after suffering a myocardial infarction is almost three times as effective, in terms of reducing mortality, as taking a statin, and that it has also been shown to reduce the rate of cardiovascular events by 30% compared with a low-fat diet.

Professor Robert Lustig, paediatric endocrinologist at the University of San Francisco, comments: “When saturated fat got mixed up with the high sugar added to processed food in the second half of the 20th century, it got a bad name. Which is worse, the saturated fat or the added sugar? The American Heart Association has weighed in – the sugar many times over. Plus added sugar causes all of the diseases associated with metabolic syndrome.

“Instead of lowering serum cholesterol with statins, which is dubious at best, how about serving up some real food?”

Dr Malhotra sums up: “It is time to bust the myth of the role of saturated fat in heart disease and wind back the harms of dietary advice that has contributed to obesity.”

doi: http://dx.doi.org/10.1136/bmj.f6340

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