Heart disease is an extremely complex problem and the hope that it can be prevented or eliminated by simply reducing cholesterol appears unfounded. After twenty years we should accept the inconsistencies of the cholesterol hypothesis and refocus our efforts on the proven benefits of a healthy lifestyle incorporating a Mediterranean diet to prevent coronary heart disease.
Nearly twenty years ago two landmark randomized clinical trials appeared in The Lancet which changed the course of medicine for patients with coronary heart disease (CHD). The 4S study used a cholesterol-lowering statin drug and reported a 30% reduction in mortality. Often overlooked is the fact that numerous studies of cholesterol lowering have failed to demonstrate a mortality benefit and the benefits of statins may have been overstated. Subsequent statin studies have led the United States Food and Drug Administration to issue warnings regarding the increased risk of diabetes and decreased cognition with statin drugs. The Lyon Diet Heart Study utilized the Mediterranean diet and reported a 70% reduction in mortality. Follow-up studies of the Mediterranean diet have confirmed these findings as well as showing a reduced risk of cancer, diabetes, and Alzheimer’s disease. The Mediterranean diet has consistently lowered cardiovascular events and mortality in numerous studies and does not typically lower cholesterol levels. Strangely enough, statins have gone on to become a multi-billion dollar industry and the foundation of many cardiovascular disease prevention guidelines while the Mediterranean diet has often been ignored.
1: DuBroff R, de Lorgeril M. Cholesterol confusion and statin controversy. World J Cardiol. 2015 Jul 26;7(7):404-9. doi: 10.4330/wjc.v7.i7.404. Review. PubMed PMID: 26225201; PubMed Central PMCID: PMC4513492.
2: de Lorgeril M, Salen P. Do statins increase and Mediterranean diet decrease the risk of breast cancer? BMC Med. 2014 Jun 5;12:94. doi: 10.1186/1741-7015-12-94. PubMed PMID: 24903828; PubMed Central PMCID: PMC4229881.
3: de Lorgeril M, Salen P. Mediterranean diet in secondary prevention of CHD. Public Health Nutr. 2011 Dec;14(12A):2333-7. doi: 10.1017/S136898001100259X. Review. PubMed PMID: 22166192.
4: Lecerf JM, de Lorgeril M. Dietary cholesterol: from physiology tocardiovascular risk. Br J Nutr. 2011 Jul;106(1):6-14. doi: 10.1017/S0007114511000237. Epub 2011 Mar 9. Review. PubMed PMID: 21385506.