Why Saturated Fat and Cholesterol Won't Kill You MRFIT STUDY:

The Multiple Risk Factor Intervention trial was a very large controlled diet trial conducted in the 1980s. It involved an initial phase in which investigators screened over 3 0!000 "en age 3 # $ %or cardiovascular risk %actors including total &lood cholesterol. They were %ollowed %or si' years. The participants did not take cholesterol#lowering drugs.

Total "ortality is nearly as high at low cholesterol levels as at high cholesterol levels. N Engl Med! "#$# %&r '()*+,"-.:#+-/"+! Seru0 1holesterol le2els and si3/year 0ortality 4ro0 stro5e in )6+7#88 0en s1reened 4or the 0ulti&le ris5 4a1tor inter2ention trial! Iso 97 a1o:s DR r7 Went;orth D7 Neaton D7 Cohen D! Di2ision o4 E&ide0iology S1hool o4 <u:li1 9ealth7 Uni2ersity o4 Minnesota7 Minnea&olis 66-66!

N=RWE>I%N 9UNT * STUDY

The study population co"prises (!08$ )orwegians! aged (0*$+ and were %ollowed#up on cause#speci%ic "ortality %or 10 years! in the 1990s.

Risk o% 4eath 5all causes6 vs Total /holesterol

1.0 1 0.9
7a.ard Ratio

0.9 0.8 0.8 0.$ 0.$ 0.1 0.1 2193 193#(30 (30#(18 3(18 7a.ard Ratio 5Men6 7a.ard Ratio 50o"en6

Total /holesterol 5"g8d96

,d-usted %or age! s"oking and systolic &lood pressure. The risk o% death is nor"ali.ed %or a total cholesterol less than 193. /learly there are %ewer all cause deaths in persons with cholesterol greater than 193. Men have the %ewest deaths when their total cholesterol is in the 19(#(30 range. 0o"en have the %ewest deaths when their total cholesterol is greater than (18.

E2al Clin <ra1t! *+"* Fe:ruary( "$,".: "6#?"'$! Is the use o4 1holesterol in 0ortality ris5 algorith0s in 1lini1al guidelines 2alid@ Ten years &ros&e1ti2e data 4ro0 the Nor;egian 9UNT * study 9al4dan <etursson7 MD7" ohann % Sigurdsson7 MD Dr 0ed7* Calle Aengtsson7 MD Dr 0ed7) To0 I B Nilsen7 Dr <hilos7- and Binn >etC7 MD <hD6 doi: "+!""""DE!")'6/*86)!*+""!+"8'8!3 <MCID: <MC))+)$$'

FR%MIN>9%M 9E%RT STUDY

The Fra"ingha" 7eart :tudy has %ollowed (09 "en and wo"en every ( years since 19+8 %or the develop"ent o% cardiovascular and other diseases. For this report! all su&-ects were %ollowed 1( years %ro" the ti"e o% 749#/ "easure"ent until death due to all causes.

Risk o% 4eath 5all causes6 vs 749 /holesterol

( 1.8
7a.ard Ratio

1.1 1.+ 1.( 1 0.8 1(#3+ 7a.ard Ratio 5Men6 7a.ard Ratio 50o"en6

3 #+0

+1#+1

+$# +

#1(9

749 /holesterol 5"g8d96

,d-usted %or total cholesterol! systolic pressure! &ody "ass inde'! cigarette use! and age. /learly the risk o% death %ro" all causes is "uch higher with low 749 cholesterol levels regardless o% total cholesterol.

%rterios1lerosis7 Thro0:osis7 and Fas1ular Aiology! "#$$( $: 8)8/8-" 9igh density li&o&rotein 1holesterol and 0ortality! The Fra0ingha0 9eart Study! < W Wilson7 R D %::ott7 W < Castelli Fra0ingha0 E&ide0iology Resear1h Se1tion7 N9BAI7 Massa1husetts! doi: "+!""'"D+"!%TF!$!'!8)8

AEG%FIAR%TE INF%RCTI=N <REFENTI=N STUDY>R=U<

This study %ollowed 11! 13 su&-ects in Israel %or 3.3 years.

,d-usted %or age! gender! 749 23 "g . dl; <= glucose 3 1(0 "g . dl; <! )>7,! previous MI! dia&etes! /?@4! hypertension! @A4! angina! current s"oking. The su&-ects were grouped into those with total cholesterol greater than 110 and those with total cholesterol less than 110. The dotted line a&ove shoes that the su&-ects with total cholesterol less than 110 died "ore o%ten than those with higher cholesterol.

Euro&ean 9eart ournal ,"##8. "$7 6*/6# Bo; total 1holesterol is asso1iated ;ith high total 0ortality in &atients ;ith 1oronary heart disease S! Aehar7 E! >ra44H7 9! Rei1her/Reiss7 F! Aoy5o7 M! Aenderly7 %! Shotan and D! Arunner 4or the AeCa4i:rate In4ar1tion <re2ention ,AI<. Study >rou&H Neu4eld Cardia1 Resear1h Institute7 She:a Medi1al Center7 Tel 9asho0er7 and H Institute o4 <hysiologi1al 9ygiene7 Edith Wol4son Medi1al Center7 9olon7 Israel