High cholesterol and coronary heart disease
Part 2: Is cholesterol really to blame?
If cholesterol did cause atherosclerosis, then the more cholesterol there is in the arteries, the more plaque there should be within the arterial walls. And as cholesterol decreases, so should the plaque.
Gofman's group obviously weren't thinking clearly or, instead of playing around with rabbits, they would have done what two other scientists had done 14 years earlier.
In 1936, Drs Kurt Landé and Warren Sperry of New York University's Department of Forensic Medicine measured blood cholesterol levels in a large number of accident victims' blood and, by dissecting their arteries, measured their degree of atherosclerosis. Landé and Sperry fully expected to find that the two were related. What they found, to their surprise, was that they were not (see Figure 1).
Landé and Sperry were very cautious, thorough and methodical; their study was well conducted. If those who later promoted the idea that blood cholesterol was to blame for CHD had read this paper before they began their research, they may well have dropped the idea right there.
Landé and Sperry's results were confirmed by further studies in the 1960s. In 1961, levels of cholesterol and the degree of atherosclerosis seen at autopsy within the arteries of twenty recently deceased patients as well as 200 more cases selected from medical libraries were measured. In all cases the measurements had been taken shortly after death. Again there was no correlation between these patients' blood cholesterol levels and the amount or severity of atherosclerotic plaque within the arteries. Cholesterol levels, whether high or low, had no impact on the growth of atherosclerotic plaque. In 1962, another team led by Dr Z. Marek searched for a correlation between cholesterol levels and atherosclerosis in a further 106 cases and came up with similar results.
Today we no longer need to wait for people to die, we can use electron beam computed tomography (EBCT) to look at and measure atherosclerosis and check cholesterol levels while people are still alive. Two scientists in New York did exactly that. They chose 182 men as their subjects and then lowered their cholesterol levels with drugs. Then, over time, they measured atherosclerosis. What they found was that lowering cholesterol made not the slightest difference.
1. Landé KE, Sperry WM. Human atherosclerosis in relation to the cholesterol content of the blood serum. Arch Path 1936; 22: 301-12.
2. Mathur KS, et al. Serum cholesterol and atherosclerosis in man. Circulation 1961; 23: 847-52.
3. Marek Z, et al. Atherosclerosis and levels of serum cholesterol in postmortem investigations. Am Heart J 1962; 63:768-74.
4. Hecht HS, Harmann SM. Relation of aggressiveness of lipid-lowering treatment to changes in calcified plaque burden by electron beam tomography. Am J Cardiol 2003; 92: 334-6.
Part 1: Beginning | Part 2: Cholesterol? No!| Part 3: Early work confirmed | Part 4: Dietary cholesterol