Madam, – Dr. Muiris Houston describes the dismay expressed by his patient who had suffered a heart attack, despite having had normal cholesterol levels (HEALTHplus, January 20th).
This phenomenon is neither rare nor surprising, given the fact that more than half of the people who suffer a heart attack have normal or low cholesterol levels. These facts are evident from many clinical studies, conducted worldwide over several decades, and supported by the longest ever running trial known as the Framingham Study.
They are confirmed by my own experience in medical practice over many years.
Public perceptions of cholesterol as the culprit in heart disease are shaped by aggressive marketing strategies from the anti-cholesterol lobby within the food and drug industry, and have nothing to do with scientific reality.
An awareness of the more sinister risk factors implicated in heart disease is clouded by the preponderance of anti-cholesterol propaganda which serves only to create confusion and unwarranted anxiety in the public mind. Current TV adverts are an example!
As physicians we have the responsibility and obligation to be honest with our patients about these facts, and to address the evidence-based risk factors for mortality, which are clearly unrelated to blood cholesterol levels. The "score system" referred to is hopelessly inadequate, since it makes use of total cholesterol figures and ignores other vital factors which have better predictive value for risk assessment, such as total-HDL ratios. My several letters on this topic which challenge the validity of stereotyped public health statements regarding cholesterol have not been published by The Irish Times. – Yours, etc,