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ATHEROSCLEROSIS AND BLOOD-CHOLESTEROL LEVEL
An exciting new finding by Dr Mark Armstrong in the United States was that the atherosclerosis in these animals gradually diminished when the abnormal diet was replaced by a low-fat diet which caused the blood cholesterol to fall. Over three to four painstaking years of observation, the narrowed arteries showed improvement in their bore, and the amount of cholesterol and even of scar tissue in their walls lessened. They did not revert entirely to normal, but the changes were remarkable. Similar studies by Dr Robert Wissler and his colleagues have shown that reduction of blood-cholesterol levels by a drug also results in slow but impressive regression of atherosclerosis caused by diet.
Hence atherosclerosis in animals can be induced by high-fat diets which raise the blood-cholesterol level, and can be lessened by diets which reduce the cholesterol level. This suggests that the association in man between a high saturated-fat diet, high blood cholesterol and coronary heart disease may indeed be cause and effect.
The evidence in man is at present incomplete. One early hint came from wartime experiences in several European countries. In Holland, Finland, Norway and Greece, coronary heart disease mortality fell during the Second World War, and this was seen in some age-groups in Great Britain too. During this period there was a sharp reduction in fat intake, and of course in cigarette smoking. In some countries the drop in heart-attack mortality was quite marked. But we cannot say with certainty which of the wartime changes in life style were responsible.
Another approach has been to study in detail small numbers of patients who have inherited conditions producing very high levels of cholesterol and fat in the blood, with consequent atherosclerosis of major arteries. Research workers have compared the arteries before and during treatment of the high cholesterol and triglyceride levels, either by taking repeated X-ray pictures of affected arteries, or by measuring blood flow. Drugs and diet, and in some instances operations, have been used to produce a steep fall in the blood cholesterol and fat levels. Drs Zelis, Buchwald, Starzl and Blankenhorn and their colleagues have independently shown that atherosclerosis in man can be lessened by such treatment.
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