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REDUCING CHOLESTEROL LEVELS: TRIALS AND RESULTS
If we choose to reduce cholesterol levels, then, it seems best to start early in life, before gross damage to the heart has occurred.
Drug treatment can be very effective in treating the high blood-cholesterol levels of patients with certain (usually inherited) illnesses. This is of value in selected individuals, but no one would advocate the community-wide use of drugs to reduce heart disease risk. All the same, the results of trials to assess the effects of such drugs are of interest.
One drug in wide use to decrease the blood cholesterol has been studied in five different trials. In otherwise-healthy men with high cholesterol levels it reduced the frequency of heart attacks. Unfortunately it did not decrease the death rate.
In 1977 Professor Carlson published the first results of an important new trial. He used a combination of two drugs to produce a very profound fall in blood cholesterol and triglyceride. In men who had a heart attack this treatment halved the frequency of further non-fatal attacks.
Another trial was published early in 1978; in it a new drug was used which may potently reduce the cholesterol level by enhancing its breakdown and excretion. In men the number of heart attacks was clearly reduced, even in those who already had heart trouble. And there was a lower death rate in men receiving the drug. It must be said that women did not show benefit from the drug in this study.
Generally the trials in which cholesterol reduction seemed beneficial were the ones in which the cholesterol level fell substantially, e.g. these recent drug trials. Where the cholesterol reduction was small, it was often not possible to detect any benefit (as in some earlier trials).
Unfortunately no perfectly designed trial of diet has been performed. It might take decades to complete such a study and the cost would be unrealizable. It appears therefore that no further purely dietary trials are in progress, and hence we may have to make up our own minds as to the value of dietary prevention on the basis of what we know already.
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