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HEART ATTACK PREVENTION: CRITICIZING PREVENTIVE DIET
The clinical trials of cholesterol reduction have not been entirely consistent. There are valid criticisms of the design of each of the published trials, including those which suggested a beneficial effect and those which did not. In the earlier trials in which prevention of a second heart attack was studied, the results have varied: at best the benefits have not been great. Others, called primary prevention trials, have sought to answer the question: ‘Does reduction of blood cholesterol reduce the chance of a physically healthy man having a first heart attack?’ Three major studies of this type have used diet to reduce the cholesterol level; all obtained results which suggested that heart-attack risk was reduced.
In practice, proposals for heart-disease prevention involve far more than reduction of cholesterol levels. The greatest chance of success must come from dealing with all known risk factors which can be altered: smoking and high blood pressure deserve the same attention as the blood cholesterol. Further, the argument for reducing cholesterol levels is not based on any one kind of evidence alone. It is based on a body of information that includes comparisons between populations, follow-up studies of single populations, dietary studies on animals and several kinds of experimental study in man as well as the clinical trials.
Another defence of the dietary status quo argues that a high-cholesterol diet does not raise the blood cholesterol much, and is consequently of no danger. But the main thrust of the prudent diet is reduction in intake of saturated fat, which has a major effect on blood-cholesterol levels, rather than of cholesterol. Such a diet inevitably contains somewhat less cholesterol; this is probably of additional benefit, certainly to a minority of cholesterol-sensitive people.
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