Cholesterol families - the start.

"As you know, her father has high cholesterol. In his family background there are at least three with moderately early heart attacks."

Not even into her teens, already total serum cholesterol 421.

Forewarned is forearmed so this girl has a better chance than her predecessors.

The cholesterol versus cardiovascular risk story thus far is quite tight.

Beyond such families it's less important.

We are indebted to the Framingham people who have cooperated over many years to provide a wealth of information¹ on this and other risk factors.

Taken in context, along with other risk factors, one can get an overall assessment of absolute risk² up the 5 or 10 year mark.

And even quite murky

Early attempts to help people by diet were distinctly unsuccessful. Saturated fat had been unjustly blamed and the different types of unsaturated fats were not known.

Cholesterol dropped but so did longevity

"The intervention group had significant reduction in serum cholesterol compared with controls (mean change from baseline −13.8% v −1.0%; P<0.001). Kaplan Meier graphs showed no mortality benefit for the intervention group in the full randomized cohort or for any prespecified subgroup. There was a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol..."

This was from the Minnesota Coronary Experiment³ (1968-73) published in The BMJ on 12 April 2016.

The Sydney Diet Heart Study⁴ had similar results...

"In this cohort, substituting dietary linoleic acid in place of saturated fats increased the rates of death from all causes, coronary heart disease, and cardiovascular disease. An updated meta-analysis of linoleic acid intervention trials showed no evidence of cardiovascular benefit."

Now there is light - and good results

It took 16 years hard work to get medicare reimbursement and provision is rolling out. Dean Ormish holds the light⁵

The web is full of wonderful people providing equally good help. They are called nutritionists, lifestyle coaches. They mostly give their own stories and have learned the hard way, by having to fix themselves first.

"There's more than one way to crack an egg" is a distinctly nicer version of the saying I learned about skinning cats. Applied to lowering cholesterol, if you're wanting to do this, one way is with >300mg/day of resveratrol.⁸

Some research

Several hundred people admitted to hospital soon after a stroke had a cholesterol test then. Progressively higher cholesterols were associated with progressively smaller strokes and progressively fewer deaths in the next ten years.⁶

In another stroke study, low HDL cholesterol was found to be associated with infections.⁷

A systematic review and meta-analysis published in June 2016 suggests a relatively small or neutral overall association of butter intake with mortality, cardiovascular disease and diabetes.⁹

Notes and references for cholesterol.

1. Framingham heart study

2. Page on cardiovascular risk

3. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73) BMJ 2016

4 Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis BMJ 2013.

5. Ornish Lifestlye Medicine™

6. Higher total serum cholesterol levels are associated with less severe strokes and lower all-cause mortality: ten-year follow-up of ischemic strokes in the Copenhagen Stroke Study.

7. High-density lipoprotein: a novel marker for risk of in-hospital infection in acute ischemic stroke patients?

8. The effects of resveratrol intervention on risk markers of cardiovascular health in overweight and obese subjects: a pooled analysis of randomized controlled trials.

9. Is Butter Back? A Systematic Review and Meta-Analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality.

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