Higher Mortality with Lower Cholesterol Numbers

From HippoEd’s Primary Care RAP:

This study found a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol.

  • Ramsden CE, et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). BMJ. 2016 Apr 12;353:i1246. PubMed PMID: 27071971

  • The objective of the study was to better understand the interaction of dietary lowering of cholesterol and mortality benefits.

  • Study design:

    • This was a re-analysis of previously unpublished data from the Minnesota Coronary Experiment (1968-1973).  This was a double blind randomized controlled trial (RCT) that was one of the largest, most detailed studies ever done on the topic.

    • The raw data was systematically reviewed.  They took the longitudinal data on the patients that had diet data.  About a quarter of the patients had an autopsy that was available at the time of death, so the authors did not have to rely only on chart reviews or diagnosis codes of death paperwork for outcomes.

    • The authors also performed a meta-analysis of all available RCTs since the 1970s which studied the lowering of serum cholesterol by providing omega-6 fatty acids from vegetable sources in place of saturated animal fats.

  • Study results:

    • The study found that as the dietary intake of linoleic acid was increased by about 280%, the serum cholesterol decreased an average of 31 mg/dL within 1 year.

    • However, this large trial did not find that the reduction in serum cholesterol due to a diet high in linoleic acid translated into a lower risk of death from coronary heart disease or all causes.

The bottom line:  There was a 22% higher risk of death for each 30 mg/dL of cholesterol reduction during this trial period.

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