In response to Dr. Cooper. The NEJM reference is Medline 17554120 and where the authors explain the 50-54% age-adjusted U.S. coronary heart disease [CHD] mortality rate drop between 1980 and 2000 by putting the old culprits, interventions and drugs into a statistics package. They generously credit the medical world for about half that drop and the balance to other reduced "risk factors". This is a bizarre exercise. It does not explain why women had rates 50% lower than men in 1980 and in 2000. Didn't women have the same diets, conventional risk factors and medical care?
Not considered was the fact that women during their reproductive years [the time period when men experience much of the decline of their arterial structure] have much lower homocysteine [~10%, U.K. NDNS V4 2004 T 4.21], a risk factor totally ignored as potentially causal but one that declined during that period, especially in the U.S.
In the "risk factor" categories they attribute 44% of the reduced mortality rate to about 5% lower cholesterol and blood pressure levels. Based on what evidence does that save lives? Is blood pressure a result of declining arterial function or a cause thereof; is it chicken or egg? There has never been a placebo controlled cholesterol or blood pressure trial in women that ever found a mortality benefit. In population studies, people over age 50 in the bottom quartile for cholesterol tend to die first while cholesterol is found not to be a risk factor for CHD death in women [Medline 15006277].
Clearly this statistical exercise, having to explain a massive amount of "deaths prevented or postponed" LACKED variables.
That some with PCSK9 loss-of-function mutations [allowing better internalization of that nutrient emulsion particle called LDL] live with less CHD is interesting [reference?] but I predict that the ongoing "K9" injectable inhibitor trials will save nobody; The jury is out, far out.
A 2015 update: in 2412 Norwegian heart patients 5 yr follow-up: total coronary events RR=0.83 in the top saturated fat quartile and RR=1.02 for all cause deaths, vs quartile 1, multivariate adjusted. Nothing significant. [doi 10.3945/jn.114.203505]
Rapid Response:
In response to Dr. Cooper. The NEJM reference is Medline 17554120 and where the authors explain the 50-54% age-adjusted U.S. coronary heart disease [CHD] mortality rate drop between 1980 and 2000 by putting the old culprits, interventions and drugs into a statistics package. They generously credit the medical world for about half that drop and the balance to other reduced "risk factors". This is a bizarre exercise. It does not explain why women had rates 50% lower than men in 1980 and in 2000. Didn't women have the same diets, conventional risk factors and medical care?
Not considered was the fact that women during their reproductive years [the time period when men experience much of the decline of their arterial structure] have much lower homocysteine [~10%, U.K. NDNS V4 2004 T 4.21], a risk factor totally ignored as potentially causal but one that declined during that period, especially in the U.S.
In the "risk factor" categories they attribute 44% of the reduced mortality rate to about 5% lower cholesterol and blood pressure levels. Based on what evidence does that save lives? Is blood pressure a result of declining arterial function or a cause thereof; is it chicken or egg? There has never been a placebo controlled cholesterol or blood pressure trial in women that ever found a mortality benefit. In population studies, people over age 50 in the bottom quartile for cholesterol tend to die first while cholesterol is found not to be a risk factor for CHD death in women [Medline 15006277].
Clearly this statistical exercise, having to explain a massive amount of "deaths prevented or postponed" LACKED variables.
That some with PCSK9 loss-of-function mutations [allowing better internalization of that nutrient emulsion particle called LDL] live with less CHD is interesting [reference?] but I predict that the ongoing "K9" injectable inhibitor trials will save nobody; The jury is out, far out.
A 2015 update: in 2412 Norwegian heart patients 5 yr follow-up: total coronary events RR=0.83 in the top saturated fat quartile and RR=1.02 for all cause deaths, vs quartile 1, multivariate adjusted. Nothing significant. [doi 10.3945/jn.114.203505]
Competing interests: No competing interests