Prevention of Coronary Heart Disease: From the Cholesterol Hypothesis to [omega]6/ [omega]3 Balance

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Harumi Okuyama
Karger Medical and Scientific Publishers, 2007 - Medical - 168 pages
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This publication is organized in an exceptional way: Each chapter introduces several completed clinical trials and provides the original conclusions and discussions of the results. The authors then contribute their own comments and interpretations of the findings, challenging the prevailing belief that serum cholesterol is a mediator of disease which is increased by eating saturated fats and decreased by eating polyunsaturated fats. They argue that upon closer scrutiny, the diet recommendations based on the cholesterol hypothesis are essentially ineffective in reducing serum cholesterol levels in the long run. Instead, it is proposed that traditional cholesterol biomarkers are of different significance in short- and long-term interventions due to the feedback control mechanisms in the body. Even more important, the association of high serum cholesterol values with high coronary heart disease mortality is not consistent when different populations are compared: This mortality rate may simply reflect the incidence and severity of familial hypercholesterolemia cases. This agrees with the observation that higher serum cholesterol values associate with lower cancer and all-cause mortalities in populations with a low relative proportion of this disorder. Thus, there seems to be no benefit of limiting dietary cholesterol intake or lowering serum cholesterol values below a certain limit. Moreover, evidence has been found that the health risk results from high intakes of calories, aggravated by an unbalanced intake of omega6/omega3 polyunsaturated fats. Based on the reviewed data, new directions of lipid nutrition are recommended for the primary and secondary prevention of coronary heart disease, cancer and all-cause deaths, which will likely revolutionize current dietary practice.

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Chapter 2
Hypercholesterolemia and Hypercholesterolemic NonFamilial Hypercholes
Cancer and AllCause Mortalities Are Lower in the Higher
Chapter 4
Postmortem Examination
Chapter 6
Why Isnt the Causal Relationship between Linoleic Acid
Chapter 8
Chapter 9

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Page 164 - Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group.
Page 159 - Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
Page 160 - Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS.
Page 160 - Hegsted DM. McGandy RB. Myers ML. Stare FJ. Quantitative effects of dietary fat on serum cholesterol in man.
Page 161 - Kannel WB, Castelli WP, Gordon T. Cholesterol in the prediction of atherosclerotic disease. New perspectives based on the Framingham study.
Page 161 - Total serum cholesterol levels and mortality risk as a function of age: a report based on the Framingham data.
Page 161 - JH (1992) Maintenance of lower proportions of n-6 eicosanoid precursors in phospholipids of human plasma in response to added dietary n-3 fatty acids.
Page 164 - Long-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men.
Page 162 - DA et al. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group. Arterioscler, Thrombo, Vas Biol 2000; (8): 1998-2004.
Page 165 - Low fat, low cholesterol diet in secondary prevention of coronary heart disease.

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