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At the heart of general practice since 1960

The Cholesterol Controversy

Just 30 years ago, a number of leading experts thought the link between cholesterol and heart disease was a sham. This fascinating book traces the evolving and fluctuating debate.

Just 30 years ago, a number of leading experts thought the link between cholesterol and heart disease was a sham. This fascinating book traces the evolving and fluctuating debate.

This book provides a fascinating account of the cholesterol debate that has raged among many eminent cardiologists, medical biochemists and lipidologists over the last five decades.

During the 1960s, 1970s and 1980s many cardiologists rejected the idea that cholesterol had anything to do with coronary artery disease.

Those who opposed the idea that raised cholesterol was the major cause of heart attacks were led by Sir John McMichael, professor of medicine at Hammersmith Hospital for 20 years and director of the British Postgraduate Medical Federation till 1970.

Another prominent critic was Professor Tony Mitchell, professor of medicine at Nottingham University from 1967 till 1990.

He wrote an editorial in 1984 insisting that the proposed links of raised cholesterol with atherosclerosis, and high serum cholesterol with coronary artery disease, were either untrue or irrelevant.

In 1963 Professor Michael Oliver reported the lipid lowering properties of clofibrate, but published data during the early 1970s by WHO investigators showed that although the drug reduced non-fatal myocardial infarcts by 25%, it raised deaths from gastrointestinal causes by 25%.

That eventually led to the demise of Atromid-S. In 1971, Akira Endo - a Japanese microbiologist - discovered the first statin, mevastatin, which was never licensed because of perceived carcinogenicity in dogs.

A second statin- lovastatin - was developed in 1987, followed by simvastatin – a semisynthetic derivative licenced for use in Britain in 1989.

That more than any other helped to settle the argument about the effectiveness of statins in reducing cholesterol and overall cardiovascular mortality. This was followed by other statins like fluvastatin, pravastatin, atorvastatin and cerivastatin.

Cerivastatin was withdrawn because of fatal side-effects, especially rhabdomyolysis. The Scandinavian Simvastatin Survival Study (4S) was published in 1994, followed by WOSCOPS in 1995, finally resolving the conflict on the role of statins in reducing coronary artery disease and overall mortality.

More recently the Heart Protection Study involving 20,000 subjects, completed at the start of the new millennium, provided definitive proof that patients treated with simvastatin had a reduced incidence of coronary events and strokes, of 26% and 27% respectively.

This book should be of particular interest to GPs, nurses treating cardiac patients and patients themselves.

It provides a captivating insight into how statins have improved the life expectancy of people with cardiovascular diseases.

Dr Krishna Korlipara

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