Are cholesterol, saturated fat less important to heart disease?

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In the editorial, the authors argued that the public-health message for preventing and treating heart disease should move away from its focus on monitoring a person’s cholesterol levels and the amount of saturated fat in his or her diet. Instead, the focus should be on reducing inflammation in the body, argued the editorial, published Tuesday (April 25) in the British Journal of Sports Medicine.
The authors, three cardiologists from England, Switzerland and the United States, also argued that the emphasis on reducing cholesterol levels in the blood through diet and medication has been “misguided.”
“The importance of blood cholesterol to a person’s risk of heart disease has been overstated,” Dr. Rita Redberg, a co-author of the editorial and a cardiologist at the University of California, San Francisco Medical Center, told Live Science.
However, some of the ideas expressed in this editorial discount decades of high-quality research and some of the best scientific studies in the field, and the paper veers off into dangerous interpretations of the existing data, said Dr. Seth Martin, a preventive cardiologist at Johns Hopkins Hospital in Baltimore. Martin was not one of the authors of the editorial.
In addition to shifting attention away from cholesterol levels, the editorial also argued that saturated fat in the diet may not be a culprit in heart disease.
Redberg said that instead of focusing primarily on reducing cholesterol levels, people at risk for heart disease are much better off working on making small improvements in lifestyle.
And although the analogy of a pipe clogged by saturated fat from the diet is popular among doctors and the public, and is used to describe what happens inside an artery of a person with heart disease, this conceptual model “is just plain wrong,” the editorial said. Moreover, the authors claimed that there is some evidence that “unclogging [the] pipe,” which is done by inserting a stent into a blocked artery, may not actually help prevent a heart attack or reduce a person’s odds of dying from such an event. The editorial makes the case that lifestyle changes can help to reduce levels of chronic inflammation, a condition the authors say contributes to heart disease. The best strategies to avoid heart disease are to eat a Mediterranean-style diet with mostly fresh foods, get regular physical activity, quit smoking and find ways to reduce stress, Redberg said.