Discussion Board

Jeff,

I posted a new topic in The Lounge: viewtopic.php?f=1&t=15478&start=0

I figured you'd see it, being a moderator, but someone suggested I post it in this board as well.

I'd appreciate your comments on it.

Thanks,
Steven

This came out this week

British Journal of Nutrition (2012), 107, 458–460

Letter to the Editor
Response to Ravnskov et al. on saturated fat and CHD
(First published online 13 December 2011)

We thank Dr Ravnskov and colleagues(1) for their interest in our editorial. Ravnskov et al. appear to ignore the large number of controlled metabolic studies relating fatty acid intake to plasma total and LDL-cholesterol as well as the overwhelming evidence that LDL is causally related to the atherosclerotic process.

The issues that Ravnskov et al. raise were raised earlier in sixty-two Letters to the Editor, which Dr Ravnskov has published about lipids and heart disease in the past 20 years(2 – 63). His letters have appeared in JAMA, the New England Journal of Medicine, the British Medical Journal, the Lancet, Science, the American Journal of Clinical Nutrition, Annals of Internal Medicine, the Journal of Clinical Epidemiology, the International Journal of Cardiology, Circu- lation, the Quarterly Journal of Medicine, the Journal of the National Cancer Institute, Nutrition Metabolism and Cardio- vascular diseases, several Scandinavian medical journals, and now in the British Journal of Nutrition.

All these letters argue essentially the same point, namely that lowering blood cholesterol levels is of unproven value. We refer readers to the responses of dozens of reputable scientists set out in each journal’s Letters section, where they have carefully responded to Dr Ravnskov’s letters and shown that, by and large, Ravnskov’s arguments are faulty.

Jan I. Pedersen Kaare R. Norum Department of Nutrition Institute of Basic Medical Sciences University of Oslo POB 1046 Blindern 0316 Oslo Norway

Philip T. James
London School of Hygiene and Tropical Medicine London UK
Ingeborg A. Brouwer Martijn B. Katan Department of Health Sciences VU University 1081 HV
Amsterdam The Netherlands

Robert Clarke
Clinical Trial Service Unit University of Oxford Oxford UK
Ibrahim Elmadfa
Institute of Nutritional Sciences University of Vienna 1090 Vienna Austria

Penny M. Kris-Etherton
Department of Nutritional Sciences Penn State University University Park PA 16802 USA
Daan Kromhout
Division of Human Nutrition Wageningen University 6700 EV Wageningen The Netherlands

Barrie M. Margetts
School of Medicine University of Southampton Southampton General Hospital Southampton UK

Ronald P. Mensink
Department of Human Biology School for Nutrition Toxicology and Metabolism Maastricht University Maastricht The Netherlands

Mike Rayner
British Heart Foundation Health Promotion Research Group Department of Public Health University of Oxford Oxford UK

Matti Uusitupa
Institute of Public Health and Clinical Nutrition
Clinical Nutrition
Kuopio Campus
University of Eastern Finland
Kuopio Finland

References
1. Ravnskov U, Diamond D, Karatay MCE, et al. (2012) No Scientific support for linking dietary saturated fat to CHD. Br J Nutr 107, 455–457.

2. Ravnskov U (1991) Are polyunsaturated fats useful? La ̈kar- tidningen 88, 1058, 1060.

3. Ravnskov U (1992) What is the correct answer in the cholesterol debate? Ugeskr Laeg 154, 1716–1718.

4. Ravnskov U (1992) Frequency of citation and outcome of cholesterol lowering trials. BMJ 305, 717.

5. Ravnskov U (1993) Cardiovascular disease in developing countries. BMJ 306, 145–146.

6. Ravnskov U (1993) Doubtful advices on cholesterol screen- ing in children. Ugeskr Laeg 155, 1886–1887.

7. Ravnskov U (1993) Reducing serum cholesterol. Lower cholesterol of doubtful benefit to anyone. BMJ 307, 125.

8. Ravnskov U (1993) New trends from the USA. The cholesterol campaign is questioned. La ̈kartidningen 90, 2528–2529.

9. Ravnskov U (1993) Coronary atherosclerosis on angio-
graphy – progress or regress, and why? Circulation 88,
1358–1360; author reply 1356–1357.

10. Ravnskov U (1993) Decreased cholesterol level shortens life.
Ugeskr Laeg 155, 3679–3680.

11. Ravnskov U (1993) Stop the cholesterol campaign!. La ̈kartid-
ningen 90, 4587–4588; discussion 4589–4590.

12. Ravnskov U (1994) Ischaemic heart disease and cholesterol. Optimism about drug treatment is unjustified. BMJ 308,
1038, 1041.

13. Ravnskov U (1994) Do polyunsaturated fats cause male
sterility? La ̈ kartidningen 91, 2308.

14. Ravnskov U (1994) Uncritical review of articles on choles-
terol. Ugeskr Laeg 156, 4479 – 4480.

15. Ravnskov U (1994) Doing the right thing: stop worrying
about cholesterol. Circulation 90, 2572 – 2573; author reply
2573 – 2577.

16. Ravnskov U (1994) Is intake of trans-fatty acids and
saturated fat causal in coronary heart disease? Circulation
90, 2568 – 2569; author reply 2573 – 2577.

17. Ravnskov U (1994) What do angiographic changes after
cholesterol lowering mean? Lancet 344, 1297.

18. Ravnskov U (1995) Fatty acids and confusing signals. Ugeskr
Laeg 157, 1534 – 1535.

19. Ravnskov U (1995) The Scandinavian Simvastatin Survival
Study (4S): hasty conclusions. Ugeskr Laeg 157, 2165 – 2166.

20. Ravnskov U (1995) Implications of 4S evidence on baseline lipid levels. Lancet 346, 181.

21. Ravnskov U (1995) Beneficial effects of simvastatin may be due to non-lipid actions. BMJ 311, 1436–1437.

22. Ravnskov U (1996) Do cholesterol-lowering drugs cause cancer? La ̈kartidningen 93, 2040.

23. Ravnskov U (1996) American College of Physicians guidelines on cholesterol screening. Ann Intern Med 125, 1010–1011.

24. Ravnskov U (1998) Experts ask for priorities when it comes to interpretation. Ravnskov answers in the debate on dietary fats. La ̈kartidningen 95, 1022–1023.

25. Ravnskov U (1998) On honesty and monounsaturated fat. La ̈ kartidningen 95, 4966.

26. Ravnskov U (1999) Misleading cholesterol statistics. La ̈kar- tidningen 96, 1947, 1949.

27. Ravnskov U (1999) Why heart disease mortality is low in France. Authors’ hypothesis is wrong. BMJ 319, 255–256.

28. Ravnskov U (2000) Prevention of atherosclerosis in children. Lancet 355, 69.

29. Ravnskov U (2000) VAT and fat. Evidence is contradictory. BMJ 320, 1470.

30. Ravnskov U (2001) Too optimistic view in mass media on statin treatment in acute myocardial infarction. La ̈kartidnin- gen 98, 2370.

31. Ravnskov U (2001) Lipid lowering doesn’t affect the deve- lopment of atherosclerosis in peripheral artery disease.
La ̈kartidningen 98, 4897–4898.

32. Ravnskov U (2001) Cholesterol and all-cause mortality in Honolulu. Lancet 358, 1907.

33. Ravnskov U (2002) Diet – heart disease hypothesis is wishful thinking. BMJ 324, 238.

34. Ravnskov U, Allen C, Atrens D, et al. (2002) Studies of dietary fat and heart disease. Science 295, 1464–1466.

35. Ravnskov U (2002) A too optimistic report of a new study on
statins. La ̈kartidningen 99, 949–951.

36. Ravnskov U (2002) Surrogate research on heart disease
and risk factors. La ̈kartidningen 99, 1507.

37. Ravnskov U (2002) Statins as the new aspirin. Conclusions
from the heart protection study were premature. BMJ 324, 789.

38. Ravnskov U (2002) The debate in Science: dietary guidelines
against myocardial infarction are defended by wrong cita-
tions. La ̈kartidningen 99, 2673.

39. Ravnskov U (2003) Statins increase the risk of cancer among
the elderly. La ̈kartidningen 100, 974.

40. Ravnskov U (2003) Lipoproteins and cardiovascular risk.
Lancet 361, 1988–1989; author reply 1989.

41. Ravnskov U (2003) ASCOT-LLA: questions about the benefits
of atorvastatin. Lancet 361, 1986; author reply 1986–1987.

42. Ravnskov U (2003) Too many calories and too little exercise cause obesity not intake of fat. La ̈ kartidningen 100,
3255 – 3256; author reply 3256.

43. Ravnskov U (2003) Dietary fat intake and risk of stroke:
allegations about dietary fat are unfounded. BMJ 327,
1348; author reply 1348 – 1349.

44. Ravnskov U (2004) Inflammation, cholesterol levels, and risk
of mortality among patients receiving dialysis. JAMA 291,
1833 – 1834; author reply 1834 – 1835.

45. Ravnskov U & Sutter MC (2004) Aggressive lipid-lowering
therapy and regression of coronary atheroma. JAMA 292,
38; author reply 39 – 40.

46. Ravnskov U (2004) Hasty conclusions on cardiac mortality
in Norway. Tidsskr Nor Laegeforen 124, 2153; author reply
2153.

47. Ravnskov U (2004) Karl Popper and the cholesterol hypothesis. Tidsskr Nor Laegeforen 124, 2517.


48. Ravnskov U, Rosch PJ & Sutter MC (2005) Intensive lipid lowering with atorvastatin in coronary disease. N Engl J Med 353, 93 – 96; author reply 93 – 96.

49. Ravnskov U (2005) Should cholesterol levels be reduced more aggressively? La ̈ kartidningen 102, 2583 – 2584; discussion 2584.

50. Ravnskov U (2005) Europe in transition: dietary fat is not the villain. BMJ 331, 906 – 907; discussion 907.

51. Ravnskov U (2006) Misleading advice on cholesterol reduction. La ̈ kartidningen 103, 568; discussion 569.

52. Ravnskov U (2006) Treatment of hypercholesterolemia- lower is not better. Ugeskr Laeg 168, 1665.

53. Ravnskov U, Rosch PJ & Sutter MC (2006) High-dose statins and the IDEAL study. JAMA 295, 2476; author reply 2478 – 2479.

54. Ravnskov U (2006) Low carbohydrate diets reduce the need 48.
of statin treatment. La ̈kartidningen 103, 3017; author reply
3017 – 3018.

55. Ravnskov U (2006) Saturated fat does not affect blood

56. Ravnskov U (2007) Lack of evidence for recommended low-density lipoprotein cholesterol treatment targets. Ann Intern Med 146, 614; author reply 614 – 615.

57. Ravnskov U (2007) Reply to “Cholesterol lowering and mortality: a sea of contradictions”. Nutr Metab Cardiovasc Dis 17, e25 – e27; author reply e21 – 23.

58. Ravnskov U (2008) Hypercholesterolaemia. Should medical science ignore the past? BMJ 337, a1681.

59. Ravnskov U (2008) Re: the association between statins and cancer incidence in a veterans population. J Natl Cancer Inst 100, 972 – 973; author reply 973 – 974.

60. Ravnskov U (2008) Should medical science ignore the past? BMJ 337, a1681 – a1681.

61. Ravnskov U (2009) Is there a reason to take the cholesterol
campaign seriously? La ̈ kartidningen 106, 47 – 48; discussion

62. Ravnskov U (2010) Statin-induced muscular problems are underestimated. Ugeskr Laeg 172, 1235; author reply 1235.

63. Ravnskov U (2011) The doubtful association between blood lipid changes and progression of atherosclerosis. Int J Cardiol 153, 95.
cholesterol. Am J Clin Nutr 84, 1551 – 1552.