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Clustering of risk factors and the risk of incident cardiovascular disease in Asian and Caucasian populations: results from the Asia Pacific Cohort Studies Collaboration
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  • Published on:
    High Cholesterol Does Not Cause Cardiovascular Disease
    • Uffe Ravnskov, Independent investigator MagleStora Kyrkogata 9, Lund, Sweden
    • Other Contributors:
      • Malcolm Kendrick, General practitioner
      • Paul J Rosch, Professor

    The main purpose of the Peters et al. study1 was to evaluate the aetiological relationships of various risk factor clusters for cardiovascular disease (CVD). We agree that all of them are associated with CVD, but association is not the same as causation. It has been known for many years that stress may be the cause of all four risk factors that have been included in the risk clusters analysed by Peters et al. Stress may for instance cause both high cholesterol, hypertension, increased coagulation and even contribute to the metabolic syndrome through a number of different mechanisms.2-6 As an old saying goes, “Not everything that can be measured matters, and not everything that matters can be measured.”
    Strongly supporting this alternative causal pathway is the fact that according to table 2 there was no correlation between total cholesterol alone and CVD; neither in the Asian nor in the Caucasian populations. This fact is in accord with our recent finding that high LDL-cholesterol is not a risk factor in elderly people (60 years and older); in fact, those with high LDL-cholesterol live the longest.7

    References
    1. Peters SAE, Wang X, Lam TH, et al. Clustering of risk factors and the risk of incident cardiovascular disease in Asian and Caucasian populations: results from the Asia Pacific Cohort Studies Collaboration. BMJ Open 2018;8:e019335. doi:10.1136/bmjopen-2017-019335
    2. Friedman M, Rosenman RH, Carroll V. Changes in the serum cholesterol...

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    Conflict of Interest:
    None declared.