The debate over the cholesterol hypothesis and statins has raged for decades. Some may point to the recent decline in cardiovascular deaths in the United States as proof of statin effectiveness, but this view fails to incorporate the impact of smoking cessation, lifestyle changes, and dramatic improvements in heart attack survival rates due to timely reperfusion and the availability of external and implantable defibrillators.
Others may argue that statins are started too late in life to be effective (the horse may already be out of the barn) and reference Mendelian randomization studies which show that rare individuals with genetically low cholesterol levels have a much lower incidence of CHD[39].
However, this concept should not be extrapolated to the 99.99% of us who lack these genes and also fails to explain how the Mediterranean diet reduces mortality within months of initiation[2-4].
In 1996 Nobel laureates Brown and Goldstein anticipated the eradication of coronary disease in their Science editorial, “Exploitation of recent breakthroughs - proof of the cholesterol hypothesis, discovery of effective drugs, and better definition of genetic susceptibility factors - may well end coronary disease as a major public health problem early in the next century”[40].
History has proven otherwise, and the global prevalence of CHD, despite worldwide statin usage and cholesterol lowering campaigns, has reached pandemic proportions. Coronary heart disease is an extremely complex malady and the expectation that it could be prevented or eliminated by simply reducing cholesterol appears unfounded.
After twenty years we should concede the anomalies of the cholesterol hypothesis and refocus our efforts on the proven benefits of a healthy lifestyle incorporating a Mediterranean diet to prevent CHD[2-4,41,42].
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