The Cholesterol Correlation – The Ancel Keys “Facts”

The Cholesterol Correlation – The Ancel Keys Facts

Extraordinary stories frequently feature extraordinary protagonists.

The story of the Cholesterol Correlation features the extraordinary Ancel Keys.

Keys was the only child of Caroline Emma Chaney Keys, a homemaker, and Benjamin Pios Keys, a bookbinder.

Shortly after their son’s birth, the couple moved to California, where they survived the earthquake in the Bay Area in 1906.

After this disaster, the family moved across the bay to Berkeley.

Ancel Keys – University of Minnesota
http://www.epi.umn.edu/cvdepi/bio-sketch/keys-ancel/

Separating media myth from reality is no easy task when it comes to Ancel Keys.

The tale begins with a “bored” Ancel Keys leaving high school to pursue a life of adventure.

Bored in high school, young Keys left home on serial adventures to dig guano in a bat cave in New Mexico, to mine gold in the Sierras, and to ship out as an oiler on a China-bound freighter.

Having taken Chinese in high school and taught himself Chinese characters en route, Keys amazed the natives in Yokohama, Japan, and in Hong Kong by communicating in writing.

Ancel Keys – University of Minnesota
http://www.epi.umn.edu/cvdepi/bio-sketch/keys-ancel/

Ancel Keys then returns to California to pursue a life of intellectual adventure.

As a high school senior in Berkeley in 1922, Keys tested highest in IQ among a sample of one thousand youths taken by Louis Terman using his newly constructed Stanford-Binet intelligence test.

Despite his poor grades in high school, Keys was admitted as an undergraduate to the University of California, Berkeley, on the recommendation of a teacher.

Ancel Keys – University of Minnesota
http://www.epi.umn.edu/cvdepi/bio-sketch/keys-ancel/

At the University of California, Berkeley, Keys initially studied chemistry, but was dissatisfied and took some time off to work as an oiler aboard the S.S. President Wilson (1st), which traveled to China.

He then returned to Berkeley, switched majors, and graduated with a B.A. in economics and political science (1925) and M.S. in zoology (1928).

For a brief time, he took up a job as a management trainee at Woolworth’s, but returned to his studies at Scripps Institution of Oceanography in La Jolla on a fellowship.

In 1930 he received his Ph.D. in oceanography and biology.

He was then awarded a National Research Council fellowship that took him to Copenhagen, Denmark to study under August Krogh at the Zoophysiological Laboratory for two years.

During his studies with Krogh, he studied fish physiology and contributed numerous papers on the subject.

Once his fellowship ended, he went to Cambridge but took some time off to teach at Harvard University, after which he returned to Cambridge and earned a second Ph.D. in physiology (1936).

In 1936 Keys was offered a position at the Mayo Foundation in Rochester, where he would continue to carry out his studies in physiology.

He only lasted a year there, citing an intellectually stifling environment where research was secondary to clinical “doc business” and playing bridge.

In 1937 he would leave the Mayo Foundation for the University of Minnesota to teach physiology; He also founded the Laboratory of Physiological Hygiene there.

https://en.wikipedia.org/wiki/Ancel_Keys

Whilst at the University of Minnesota the ever adventurous Ancel Keys approached the Quartermaster Food and Container Institute regarding emergency rations only to be told that he should “leave such things to the professionals”.

Undaunted, Ancel Keys proceeded to develop his 3,200 calories per day K-ration diet.

The initial ingredients of the K-ration were procured at a local Minneapolis grocery store -hard biscuits, dry sausage, hard candy, and chocolate.

The final product was different from Keys’ original ingredients, but most of Keys initial suggestions made it to the final product.

K-Ration

https://en.wikipedia.org/wiki/Ancel_Keys

It was originally intended as an individually packaged daily ration for issue to airborne troops, tank corps, motorcycle couriers, and other mobile forces for short durations.

The K-ration provided three separately boxed meal units: breakfast, dinner (lunch) and supper (dinner).

He then tested his 28-ounce, 3,200 calorie (871 gram, 13,400 kJ) meals on six soldiers in a nearby army base.

The meals only gained “palatable” and “better than nothing” ratings from the soldiers, but were successful in relieving hunger and providing sufficient energy.

https://en.wikipedia.org/wiki/K-ration

However, in retrospect, Ancel Keys should have left “such things to the professionals” because “highly active men” experienced “malnutrition” whilst enjoying the delights of K-rations.

One major criticism of the K-ration was its caloric and vitamin content, judged as inadequate based on evaluations made during and after World War II of the ration’s actual use by Army forces.

Because of the short duration and hasty nature of experimental testing of the K-ration before adoption, ration planners did not realize that soldiers fighting, digging, and marching in extreme conditions would require many more calories per day than a soldier marching over cleared roads in temperate climates.

As it was based on an emergency ration, the K-ration provided roughly 800 – 1,200 calories fewer than required by highly active men, especially those working in extreme heat or bitter cold, and malnutrition became evident.

https://en.wikipedia.org/wiki/K-ration

The saga of the K-ration concludes with the first Ancel Keys conundrum.

Though a few sources claim the name was unrelated to Keys, many historical references support the claim that the K-ration was indeed named after him.

https://en.wikipedia.org/wiki/Ancel_Keys

Although rumor has it that it was named after Dr. Keys or was short for “Kommando” (as elite troops were the first to receive it), the letter “K” was selected because it was phonetically distinct from other letter-name rations.

https://en.wikipedia.org/wiki/K-ration

Ancel Keys then progressed from unintentional malnutrition to deliberate malnutrition with his 1,800 calories per day Starvation Diet.

To gain insight into the physiology of starvation, in 1944 Keys carried out a starvation study with 36 conscientious objectors from Civilian Public Service as test subjects in the Minnesota Starvation Experiment.

At the time, conscientious objectors were being placed in virtual concentration camps, with a few functioning like the Civilian Public Service, so that recruiting them would prove easier than seeking out volunteers in the general population.

The participants would first be placed on the three month baseline diet of 3200 calories after which their calories were reduced to 1800 calories/day while expending 3009 calories in activities such as walking.

The final three months were a refeeding period where the volunteers were divided into four different groups.

https://en.wikipedia.org/wiki/Ancel_Keys

Starvation Diet

They Starved So That Others Be Better Fed:
Remembering Ancel Keys and the Minnesota Experiment
Leah M. Kalm and Richard D. Semba1 – 2005 – The Journal of Nutrition
http://jn.nutrition.org/content/135/6/1347.full

The full report of results from the Minnesota Starvation Experiment was published in 1950 in a two-volume, 1,385-page text entitled The Biology of Human Starvation (University of Minnesota Press).

https://en.wikipedia.org/wiki/Minnesota_Starvation_Experiment

The Starvation Diet presents the second Ancel Keys conundrum regarding his ethics.

Indeed, most of the subjects experienced periods of severe emotional distress and depression.

There were extreme reactions to the psychological effects during the experiment including self-mutilation (one subject amputated three fingers of his hand with an axe, though the subject was unsure if he had done so intentionally or accidentally).

https://en.wikipedia.org/wiki/Minnesota_Starvation_Experiment

He also ordered the men to maintain an active lifestyle, working jobs in the lab and walking a minimum of 22 miles a week.

The stress proved too much for one of the men, twenty-four-year-old Franklin Watkins.

He began having vivid, disturbing dreams of cannibalism in which he was eating the flesh of an old man.

Finally Keys confronted him, and Watkins broke down sobbing.

Then he grew angry and threatened to kill Keys and take his own life.

Keys immediately dismissed Watkins from the experiment and sent him to the psychiatric ward of the university hospital.

Perhaps because of the amount of water they were drinking, the men developed edema (retention of water). Their ankles, knees, and faces swelled — an odd physical symptom given their otherwise skeletal appearance.

The skin of some of the men developed a coarse, rough appearance, as a result of the hardening of their hair follices.

Other effects included dizziness, muscle soreness, reduced coordination, and ringing in their ears.

But the creepiest change, which occurred in all of the men, was a whitening of their eyeballs as the blood vessels in their eyes shrank.

Their eyes eventually appeared brilliantly, unnaturally white, as if made out of porcelain.

From the men’s point of view, the most uncomfortable change was the lack of body fat.

It became difficult for them to sit down for long periods of time because their bones would grind against the seats.

They also felt cold all the time.

Although they were now in the rehabilitation phase, Keys didn’t significantly increase their food levels.

Instead, he divided them into four subgroups, which received 400, 800, 1200 or 1600 more calories than they had in starvation.

They still felt hungry all the time.

Keys simultaneously gave some of them vitamin and protein supplements, to see if these would aid their recovery.

After a few weeks it became apparent to Keys that the supplements were doing nothing to help the men.

In fact, the men in the lowest calorie group weren’t recovering at all.

The only thing that seemed to help was more food.

So Keys boosted the food intake of each group by 800 calories, and this had a quick and positive effect.

He eventually concluded that in order to recover from starvation, a person needs around 4000 calories a day to rebuild their strength.

The Great Starvation Experiment, 1944-1945
http://www.madsciencemuseum.com/msm/pl/great_starvation_experiment

Such an experiment would not be allowed now as medical ethics have evolved, but back then, it was OK.

The Great Starvation Experiment – Todd Tucker (2006)
https://ravingreader.wordpress.com/2012/01/18/the-great-starvation-experiment-todd-tucker-2006/

Ancel Keys then began his adventures in the realm of heart disease.

By 1947 Keys had begun to consider heart attack in the United States as an epidemic, projecting its continued rise, associating it with changed lifestyles and eating patterns after the war, and proposing new research approaches to its causes and prevention.

Ancel Keys – University of Minnesota
http://www.epi.umn.edu/cvdepi/bio-sketch/keys-ancel/

The Minnesota Business and Professional Men study was the first systematic cohort study of characteristics measured in healthy participants for their value in predicting heart attacks.

It had no a priori hypotheses, but measured a number of potential risk factors.

From 1948-1963, 32 deaths occurred in the cohort, 17 of which were attributed to coronary heart disease.

Minnesota Business and Professional Men’s Study
http://www.epi.umn.edu/cvdepi/study-synopsis/minnesota-business-and-professional-mens-study/

Ancel Keys 1947

http://www.epi.umn.edu/cvdepi/photograph/ancel-keys-demonstrated-the-epidemiological-transition-in-1947/

Whilst travelling in Europe during 1952 Ancel Keys convinced himself that high levels of cholesterol caused heart disease.

As with many other fears, fear of dietary fat originated in alarm over a supposed epidemic – in this case, of coronary heart disease.

The best known advocate of this theory was Ancel Keys, a physiologist at the University of Minnesota in Minneapolis.

After the Second World War, Keys became curious about something that kept cropping up in local newspapers.

Many local business executives were being struck down with sudden heart attacks.

The most likely cause of the attacks was smoking, but Keys wasn’t looking for that.

He tested 286 middle-aged businessmen and found high levels of cholesterol in their blood.

He soon concluded that this buildup of cholesterol was the main culprit in the businessmen’s heart attacks.

A few years later, in 1952, Keys found support for his theory on a visit to Naples, Italy.

There, he was told that practically the only coronary patients in the city’s hospitals were rich men in private hospitals.

(No one seems to have told him that poorer Italians, especially in the south, clung – often with good reason – to the old notion that few patients emerged from hospitals alive and avoided them at all costs.)

Later that year, in Madrid, Keys took blood samples from some men in one of the city’s working-class quarters, where heart disease was also said to be rare.

Then he did the same with 50 well-off patients of a prominent Spanish doctor who had told him that heart disease was rife among them.

Lo and behold, the Naples firemen and poor people in Madrid had significantly lower levels of cholesterol in their blood than the wealthy madrileños, whose serum cholesterol levels were as high as those of the Minnesota businessmen.

Junk Science Week: Lipophobia and the bad science diet – Financial Post – 11June 2012
http://business.financialpost.com/2012/06/11/book-excerpt-lipophobia-and-the-bad-science-diet/

In 1953 Ancel Keys unleashed his “facts” about cholesterol upon an unsuspecting public.

Incredibly, in his opening paragraph Keys admits that his “facts” may not actually be associated with cardio-vascular disease because the “condition cannot be precisely evaluated in life, and is all too seldom verified at death”.

The first part of the title of this paper may be a misnomer.

There is no guarantee that the main points of this discussion are actually about arteriosclerosis or the particular variety labelled atherosclerosis.

Since the pathological condition cannot be precisely evaluated in life, and is all too seldom verified at death, it is proper to leave the pathologist in command of his own field and to stay within the limits of the facts on which this discussion actually depends; these are the facts seen, recorded, and measured by the clinician, the biochemist and the vital statistician.

Atherosclerosis: a problem in newer public health – Ancel Keys
Journal of Mount Sinai Hospital NY 1953; 20:118-39
http://originaleating.org/files/Keys,_Atherosclerosis,_A_Problem_in_Newer_Public_Health.pdf

Atherosclerosis (also known as arteriosclerotic vascular disease or ASVD) is a specific form of arteriosclerosis in which an artery wall thickens as a result of invasion and accumulation of white blood cells (WBCs).

The accumulation of the WBCs is termed “fatty streaks” early on because of appearance being similar to that of marbled steak.

These accumulations contain both living, active WBCs (producing inflammation) and remnants of dead cells, including cholesterol and triglycerides.

http://en.wikipedia.org/wiki/Atherosclerosis

Arteriosclerosis is the thickening, hardening and loss of elasticity of the walls of arteries…

This process gradually restricts the blood flow to one’s organs and tissues and can lead to severe health risks brought on by atherosclerosis, which is a specific form of arteriosclerosis caused by the buildup of fatty plaques, cholesterol and some other substances in and on the artery walls.

http://en.wikipedia.org/wiki/Arteriosclerosis

According to the lipid hypothesis, abnormal cholesterol levels (hypercholesterolemia) – or, more properly, higher concentrations of LDL particles and lower concentrations of functional HDL particles – are strongly associated with cardiovascular disease because these promote atheroma development in arteries (atherosclerosis).

This disease process leads to myocardial infarction (heart attack), stroke, and peripheral vascular disease.

https://en.wikipedia.org/wiki/Cholesterol#Clinical_significance

Nevertheless, he then proceeds to present his “facts” based upon a presumed relationship between “serum cholesterol and allied substances” and “degenerative heart disease”.

The facts to be discussed here concern three sets of items;

1) The first is the broad category of heart disease, or diseases, diagnosed by the clinician as angina pectoris, coronary heart disease, myocardial infarction, chronic myocarditis, and myocardial degeneration. In hospital and vital statistics it is rarely possible to differentiate these clearly so it is convenient to group them, for the present purposes as “degenerative heart disease.”

2) The second set of items concerns serum cholesterol and allied substances which are currently considered to be importantly related to the development of some, at least, of these conditions in man. The relationship is presumably through the atherosclerotic process but this assumption is not central for my argument.

3) Finally, there is the relationship of the diet to the concentration of cholesterol and allied substances in the serum and to the death rate of the death rate of the adult population.

Atherosclerosis: a problem in newer public health – Ancel Keys
Journal of Mount Sinai Hospital NY 1953; 20:118-39
http://originaleating.org/files/Keys,_Atherosclerosis,_A_Problem_in_Newer_Public_Health.pdf

Keys also states his correlation is “far from perfect” and unreliable for “single individuals”.

All of this indicates that measurements of cholesterol and allied substances in the blood serum afford an indication of the tendency towards the development of atherosclerosis and degenerative heart disease.

But two questions arise at once.

How reliable is the indication derived from such measurement?

And is one or the other of the various measurements much superior to the others for the recognition or prediction of degenerative heart disease in man?

In one sense the reliability is high.

Whenever groups of individuals are compared, all of the measurements invariably seem to show statistically significant correlations between the measurement and the presence or absence of the tendency towards degenerative heart disease.

But the correlations are far from perfect and the reliability is low for single individuals.

Atherosclerosis: a problem in newer public health – Ancel Keys
Journal of Mount Sinai Hospital NY 1953; 20:118-39
http://originaleating.org/files/Keys,_Atherosclerosis,_A_Problem_in_Newer_Public_Health.pdf

Presumably, Keys hoped his audience would ignore his “facts” and simply accept the graphics.

Dietary Fat
Atherosclerosis: a problem in newer public health – Ancel Keys
Journal of Mount Sinai Hospital NY 1953; 20:118-39
http://originaleating.org/files/Keys,_Atherosclerosis,_A_Problem_in_Newer_Public_Health.pdf

Unsurprisingly, his “facts” were vigorously challenged by experts in atherosclerosis during 1955.

The Seven Countries Study was apparently motivated, in part, from the 1955 expert meeting on atherosclerosis at the World Health Organization in Geneva.

There Ancel Keys presented his diet-lipid-heart disease hypothesis with his usual confidence and bluntness.

He was taken aback by the vigorous challenge from Sir George Pickering who asked him, in this approximation: “If you would be so kind, Professor Keys, what do you consider the single best piece of evidence to support your diet-heart idea?”

Keys fell for the trick by this Oxford debating expert and answered the question with a piece of evidence.

The assembled experts were quickly able to diminish the significance of that bit of evidence.

Famous Polemics on Diet-Heart Theory
http://www.epi.umn.edu/cvdepi/essay/famous-polemics-on-diet-heart-theory/

On the other hand, pharmacology was interested in his “facts”.

The cholesterol-lowering properties of nicotinic acid were discovered in 1955 by Canadian pathologist Rudolf Altschul.

At that time, nicotinic acid was the only drug effective in lowering both cholesterol and triglycerides.

A historical perspective on the discovery of statins – Akira Endo
Proc Jpn Acad Ser B Phys Biol Sci. 2010 May 11; 86(5): 484–493
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108295/

Niacin (also known as vitamin B3 or nicotinic acid) is an organic compound with the formula C6H5NO2 and, depending on the definition used, one of the 20 to 80 essential human nutrients.

http://en.wikipedia.org/wiki/Niacin

During 1956 research at the University of California at Berkeley identified:
1) A correlation between “heart attacks” and “elevated levels of blood cholesterol”.
2) A correlation between “heart attacks” and “high density lipoprotein”.

By definition, neither of these correlations implied causality.

In the early 1950s, the epidemiologic study of the cholesterol-coronary connection was unfolded by John Gofman at the University of California at Berkeley, who used the newly developed ultracentrifuge to separate plasma lipoproteins by flotation.

Gofman found not only that heart attacks correlated with elevated levels of blood cholesterol but also that the cholesterol was contained in low density lipoprotein (LDL).

He also observed that heart attacks were less frequent when the blood contained elevated levels of high density lipoprotein (HDL)

Gofman J.W., Lindgren F.T., Elliott H. (1949)
Ultracentrifugal studies of lipoproteins of human serum. J. Biol. Chem. 179, 973–979

Gofman J.W., Lindgren F.T., Elliott H., Manz W., Hewitt J., Herring V. (1950)
The role of lipids and lipoproteins in atherosclerosis. Science 111, 166–171

Gofman J.W. (1956) Serum lipoproteins and the evaluation of atherosclerosis.
Ann. N.Y. Acad. Sci. 64, 590–595

A historical perspective on the discovery of statins – Akira Endo
Proc Jpn Acad Ser B Phys Biol Sci. 2010 May 11; 86(5): 484–493
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108295/

However, the “facts” were good enough for the American Heart Association and the American government to promote the Cholesterol Correction as Settled Science.

As a result, in 1956 representatives of the American Heart Association appeared on television to inform people that a diet which included large amounts of butter, lard, eggs, and beef would lead to coronary heart disease.

This resulted in the American government recommending that people adopt a low-fat diet in order to prevent heart disease.

https://en.wikipedia.org/wiki/Ancel_Keys

1956 also marked the point where Ancel Keys became a mainstream Settled Scientists.

When Keys was hired at the Mayo Foundation in 1936, he hired Margaret Haney (1909–2006) as a medical technologist.

In 1939 they married and had three children: Carrie D’Andrea, Henry Keys, and Martha McLain (deceased, 1991).

Together, they coauthored numerous books, including Eat Well and Stay Well (Doubleday, 1959) and The Benevolent Bean (Doubleday, 1967).

They also traveled the world, traveling to places like Japan and South Africa to record data for Ancel’s published works such as the Seven Countries Study.

https://en.wikipedia.org/wiki/Ancel_Keys

The Seven Countries Study is an epidemiological longitudinal study directed by Ancel Keys at what is today the University of Minnesota Laboratory of Physiological Hygiene & Exercise Science (LPHES).

The study was first published in 1970 and then as a book published by Harvard University Press.

As of 2015, heated scientific debate continues.

The Seven Countries Study was formally started in fall 1958 in Yugoslavia. In total, 12,763 males, 40–59 years of age, were enrolled as 16 cohorts, in seven countries, in four regions of the world (United States, Northern Europe, Southern Europe, Japan).

The Seven Countries Study has continued for more than 50 years.

https://en.wikipedia.org/wiki/Seven_Countries_Study

Keys had concluded that saturated fats as found in milk and meat have adverse effects opposite to the beneficial effects of the unsaturated fats found in vegetable oils.

This message was obscured for a 20-year period starting around 1985, when all dietary fats were considered unhealthy.

https://en.wikipedia.org/wiki/Ancel_Keys

The cloak of respectability worn by most Settled Scientists appears to have protected Ancel Keys [in the medium term] from any criticism that implied his data had been cherry-picked so he could construct his startling 1953 correlation graphic.

Cholesterol graphs

Analysis of all available data shows that:

1. The apparent association is greatly reduced when tested on all countries for which data are available instead of the six countries used by another investigator.

2. The basic data are subject to considerable limitations.
This applies to both the components of the diet in the difference countries and to mortality, especially to the classification of causes of death.

3. The presumed association is not “specific” for fat in the diet or for diseases of the heart; for example, the association with heart disease mortality is stronger when animal protein is substituted for fat, and a strong negative association is found both for animal protein and fat with mortality from noncardiac diseases.

4. It is concluded that the suggested association between national death rates for heart disease and percentage of fat in the diet available for consumption cannot at the present time be accepted as valid.

5. It is suggested that in indirect studies of association it is the responsibility of the investigator to report the basis on which the primary data were selected, their limitations, any qualifying conditions or considerations, and the method used for testing the validity of the results.

Fat in the diet and mortality from heart disease – a methodologic note.
J. Yerushalmy & H. E. Hilleboe – N. Y. State J. Med.57, 2343–2354 (1957).
https://thescienceofnutrition.files.wordpress.com/2014/03/fat-in-the-diet-and-mortality-from-heart-disease1.pdf

The Cholesterol Correlation then gathered momentum as a series of drugs hit the market.

Clofibrate was synthesized at Imperial Chemical Industries (ICI) in England and marketed in 1958.

In the 1960s, many derivatives of clofibrate, called fibrates, that were more potent and safer than clofibrate were developed.

In most patients, the cholesterol-lowering effect of fibrates was minimal to moderate.

A historical perspective on the discovery of statins – Akira Endo
Proc Jpn Acad Ser B Phys Biol Sci. 2010 May 11; 86(5): 484–493
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108295/

The World Health Organization Cooperative Trial on Primary Prevention of Ischaemic Heart Disease using clofibrate to lower serum cholesterol observed excess mortality in the clofibrate-treated group despite successful cholesterol lowering (47% more deaths during treatment with clofibrate and 5% after treatment with clofibrate) than the non-treated high cholesterol group.

These deaths were due to a wide variety of causes other than heart disease, and remain “unexplained”.

Clofibrate was discontinued in 2002 due to adverse affects.

https://en.wikipedia.org/wiki/Clofibrate

Triparanol, which was introduced into clinical use in the U.S. in 1959, was the first cholesterol-lowering agent that inhibited cholesterol synthesis.

However, it was withdrawn from the market in the early 1960s because of serious side effects, including cataracts. Triparanol inhibited the final stage in the cholesterol synthetic pathway, resulting in the accumulation of other sterols.

Proc Jpn Acad Ser B Phys Biol Sci. 2010 May 11; 86(5): 484–493
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108295/

Then in 1961 the Cholesterol Correlation made the cover of Time Magazine.

The Department of Agriculture averaged out U.S. food consumption last year at 1,488 Ibs. per person, which, allowing for the 17 million Americans that John Kennedy said go to bed hungry every night, means that certain gluttons on the upper end must somehow down 8 Ibs. or more a day.

http://content.time.com/time/magazine/article/0,9171,828721,00.html

http://content.time.com/time/covers/0,16641,19610113,00.html

Another accolade arrive for the Cholesterol Correlation when Konrad Bloch and Feodor Lynen received the Nobel Prize in Medicine or Physiology in 1964 for discoveries concerning the mechanism and regulation of the cholesterol and fatty acid metabolism.

Nobel Prize in Medicine or Physiology in 1964

At the Nobel Banquet in Stockholm, December 10, 1964 when Konrad Bloch and Feodor Lynen, were awarded the Nobel Prize, S. Friberg, Rector of the Caroline Institute, made the following remarks:

“Your discoveries may provide us with weapons against some of mankind’s gravest maladies, above all in relation to cardiovascular diseases. Achievements like yours make it not unrealistic to look forward to a time, when mankind will not only live under vastly improved conditions, but will itself be better”.

A historical perspective on the discovery of statins – Akira Endo
Proc Jpn Acad Ser B Phys Biol Sci. 2010 May 11; 86(5): 484–493
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108295/

Finally, the Cholesterol Correlation hit the jackpot with the discovery of statins.

As of 2010, a number of statins are on the market: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

Several combination preparations of a statin and another agent, such as ezetimibe/simvastatin, are also available.

In 2005 sales were estimated at $18.7 billion in the United States.

The best-selling statin is atorvastatin, which in 2003 became the best-selling pharmaceutical in history.

The manufacturer Pfizer reported sales of US$12.4 billion in 2008.

To market statins effectively, Merck had to convince the public of the dangers of high cholesterol, and doctors that statins were safe and would extend lives.

As a result of public campaigns, people in the United States became familiar with their cholesterol numbers and the difference between “good” and “bad” cholesterol, and rival pharmaceutical companies began producing their own statins, such as pravastatin (Pravachol), manufactured by Sankyo and Bristol-Myers Squibb.

In April 1994, the results of a Merck-sponsored study, the Scandinavian Simvastatin Survival Study, were announced.

Researchers tested simvastatin, later sold by Merck as Zocor, on 4,444 patients with high cholesterol and heart disease.

After five years, the study concluded the patients saw a 35% reduction in their cholesterol, and their chances of dying of a heart attack were reduced by 42%.

In 1995, Zocor and Mevacor both made Merck over US$1 billion.

https://en.wikipedia.org/wiki/Statin

However, the arguments concerning causation still rumble on especially as there is a significant correlation between higher cholesterol levels and lower mortality rates.

In The Great Cholesterol Con, Dr Malcolm Kendrick analysed some World Health Organisation (WHO) data.

The WHO has extensive data from almost 200 countries on more health measures than you could imagine – definitely worth a look one rainy afternoon.

This is where Kendrick presented the world with two different Seven Country Studies.

Kendrick took the seven countries with the lowest saturated fat intake and then the seven countries with the highest saturated fat intake.

Cholesterol-lowering-enthusiasts may need to read this twice – but he found: “Every single one of the seven countries with the lowest saturated fat consumption has significantly higher rates of heart disease than every single one of the countries with the highest saturated fat consumption.”

As Kendrick’s two unbiased seven country studies showed – there is not even an association between saturated fat and heart disease – let alone causation.

Male Deaths vs Cholesterol

There is a significant association between higher cholesterol levels and lower deaths and lower cholesterol levels and higher deaths for men and an even more significant relationship for women.

Obesity, Cholesterol and Death Rates – Zoë Harcombe
http://www.spacedoc.com/obesity_cholesterol_death_rates_2

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4 Responses to The Cholesterol Correlation – The Ancel Keys “Facts”

  1. malagabay says:

    Heart of the Matter Part 1 Dietary Villains

  2. malagabay says:

    Heart of the Matter Part 2 – Statin Drugs Myth

  3. Pingback: The Cholesterol Correlation – The Elephant in the Room | MalagaBay

  4. Pingback: The Cholesterol Correlation – The Caesium-137 Correlation | MalagaBay

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