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Executive Summary

CHOLESTEROL RELATIONSHIP TO HEART DISEASE HAS BEEN CONFIRMED by numerous studies, the American Heart Association and the National Heart, Lung and Blood Institute assert in a joint statement refuting recent arguments against a cholesterol/heart disease link. AHA and NHLBI cited a number of studies, including the Framingham Heart Study, the Multiple Risk Factor Intervention Trial (MRFIT), the Coronary Primary Prevention Trial and the Helsinki Heart Study, as demonstrating a "powerful link between cholesterol and coronary heart disease." The 18-page statement was released at the American Heart Association's annual scientific meeting, held Nov. 13-16 in New Orleans. The report, commissioned by AHA's Task Force on Cholesterol Issues, answers the criticisms of popular magazine writers and "a small group of physicians" that "the relation between cholesterol and heart disease is not well-defined, that cholesterol lowering does not extend life, that low-saturated fat, low-cholesterol diets do little to reduce the risk of heart disease, and that cholesterol lowering is a waste of time and money." AHA and NHLBI point out that results from the Coronary Primary Prevention Trial and the Framingham Study "indicate that a 1% reduction in an individual's total cholesterol level translates into an approximate 2% reduction in coronary heart disease risk." They add that a recent analysis of the literature indicates that the relationship between the two may actually be stronger than the 1:2 ratio. Responding to the criticism that there is no evidence lowering cholesterol will reduce overall death rates, AHA and NHLBI note that three recent studies -- the Coronary Drug Project, the Oslo Study Diet and Antismoking Trial, and the Stockholm Ischemic Heart Disease Study -- have shown that lowering cholesterol reduces total mortality. In NHLBI's Coronary Drug Project, 1,119 men who received nicotinic acid for six years "experienced 29% fewer heart attacks than the 2,789 men in the placebo group" and nine years later had 11% fewer deaths than the placebo group. The Oslo trial of 1,200 men, conducted over five years, found that the intervention group had 33% fewer deaths five years after the close of the trial and 40% fewer deaths eight to nine years after the end of the trial. AHA and NHLBI add, however, that "the successes of these three studies may mask an important point: A reduction in total mortality might not be the best index of the value of cholesterol lowering. By preventing the occurrence of nonfatal heart attacks, the incidence and prevalence of chronic coronary heart disease is reduced." Arguing that cholesterol interventions are cost-effective, AHA and NHLBI note that approximately 1.5 million Americans suffer a heart attack each year and approximately 300,000 coronary bypass surgeries are done annually. The AHA estimates the direct medical care costs for coronary heart disease at $ 34.9 bil. in 1989 and the total economic cost at $ 100 bil. annually. "A 10% reduction in serum cholesterol levels in the population, which should be possible by dietary modification alone, ought to result in a decrease in coronary heart disease rates of about 20%," AHA and NHLBI state. "This translates into an annual saving of $ 20 bil."

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