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RISK FROM A HIGH BLOOD-CHOLESTEROL LEVEL AT DIFFERENT AGES
The risk due to a high cholesterol level increases with its duration. Hence the very high risk due to familial hypercholesterolemia may partly be due to the fact that this condition is present from birth. Earlier we argued that reduction of cholesterol levels is best attempted at as early an age as possible. High cholesterol levels 111 children may be far commoner than has been assumed. In Holland it has been claimed by Dr de Haas that 10 to 30 per cent of pre-school children have a high blood-cholesterol level.
The other side of the coin is that reduction of blood cholesterol at an advanced age may be less worth while than when carried out early in life. Certain other factors, notably high blood pressure and probably diabetes, continue to increase heart-attack risk in the over-sixties; and a high level of low-density lipoprotein (LDL) still confers risk. High-density lipoprotein (HDL) remains a protective factor in the elderly, as shown by the research workers at Framingham.
What about cholesterol levels in the person who has already had a heart attack? Do they affect his chances of further trouble? Studies in California and in Norway and a large-scale American trial known as the Drug-Heart Study, showed that men with coronary disease who have high cholesterol levels were more likely to have a further heart attack than those with lower levels. This suggests that it may be of value to reduce cholesterol levels even after a heart attack. Not all studies have confirmed this. Pending fuller agreement, it is reasonable to say that cholesterol reduction is more likely to benefit individuals without overt coronary heart disease; but reasonable measures to lower the blood cholesterol should be followed by people, especially younger ones, who have had a heart attack. As discussed earlier, some of the controlled trials on patients who already have heart disease suggest that such measures are of value.
Fat consumption and the blood cholesterol are among many factors which alter the risk of a heart attack; they may play a uniquely important role, as we have seen. An unnecessary amount of controversy has been created about this role; hence it is worth spelling out the evidence in detail. It is interesting to reflect on how long it sometimes takes to implement medical discoveries. In the nineteenth century the role of bacteria in causing illness was shown by Pasteur, Koch and Semmelweiss. Many doctors at the time rejected the scientific evidence completely; they turned the painstaking research upside down and claimed that bacteria appeared in inflamed tissues as a consequence of disease! Such attitudes must have delayed for many years the impact of these great men on the prevention and treatment of infectious diseases.
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