is a contribution from members of THINCS,
The International Network of Cholesterol Skeptics
In a JAMA paper (ref 1) Stamler and Neaton publish a
number of false statements in support of the cholesterol campaign. Here is our comment to his paper. The
On The Unimportance of MRFIT and Relative Risk
Stamler and Neaton's
insinuation that increased serum cholesterol causes a continuous, graded
increase in coronary heart disease (CHD)1 continues to confuse
risk markers, which are merely statistical associations, with risk factors
that have a causal contribution.2 Their recommendation that
dietary fat intake and serum cholesterol should be lowered as much as
possible in everyone are also refuted by numerous studies published since
their MRFIT paper.2,3 High cholesterol is not a risk factor for
women, diabetics, CHD patients, senior citizens (in whom ninety percent of
all cardiovascular deaths occur), and is associated with reduced mortality
in the elderly because of its protective effects.4
No mention was made of HDL,
diastolic BP, blood sugar vs. "reported diabetes", or how
"excess deaths attributable to serum cholesterol levels 180 mg/dL or
greater" were "estimated". The strong, linear relationship in
the original MRFIT paper became trivial and non-linear after exclusion of
the smokers,5 Werkö has enumerated other questionable and
inconsistent study reports, such as the variation in number of screeenies
from 316,099 to 361,266 and the dubious likelihood that all could have been
tracked after 6-12 years.6
1. Stamler J, Neaton JD. The Multiple Risk Factor Intervention Trial (MRFIT)
importance then and now. JAMA 2008;300(11):1343-1345.
2. Rosch PJ. Cholesterol does not cause coronary heart disease in contrast
to stress. Scand Cardiovasc J. 2008 Aug;42(4):244-9.
3. Ravnskov U, Rosch PJ, Houston MC. Should we lower cholesterol as much as
possible? BMJ 2006;332:1330-1332.
4. Ravnskov U. Should medical science ignore the past? BMJ 2008;337:a1681.
5. Shaten BJ, Kuller LH, Neaton JD. Association between baseline risk factors, cigarette
smoking, and CHD mortality after 10.5 years. MRFIT Research Group. Prev
Med 1991 ;20:655-9.
6. Werkö L. Analysis of the MRFIT screenees: a methodological study. J
Intern Med 1995; 237:507-18.
Paul J. Rosch, MD, FACP
President, The American Institute of Stress
Clinical Professor of Medicine and Psychiatry
New York Medical College
Uffe Ravnskov, MD, PhD
Independent Researcher, Lund, Sweden
And here comes the editor´s
Thank you for your recent letter to the editor. Unfortunately, because of
the many submissions we receive and our space limitations in the Letters
section, we are unable to publish your letter in JAMA.
After considering the opinions of our editorial staff, we determined your
letter did not receive a high enough priority rating for publication in
JAMA. We are able to publish only a small fraction of the letters submitted
to us each year, which means that published letters must have an extremely
We encourage you to contact the corresponding author of the article,
although we cannot guarantee a response. We do appreciate you taking time to
write to us and thank you for the opportunity to look at your letter.
Robert M. Golub, MD
Letters Section Editor, JAMA
unpublished contributions by members of THINCS