Cholesterol reduction and health policy: taking clinical science to patient care
Epstein, A.M.; Oster, G.
Annals of Internal Medicine 106(4): 621-623
1987
ISSN/ISBN: 0003-4819 PMID: 3826961 Document Number: 290023
For more than a decade, the relation between cholesterol and coronary heart disease has been a subject of controversy in the medical community. Whereas numerous epidemiological studies have documented a consistent, strong and independent association between cholesterol concentrations and the incidence of coronary heart disease, evidence that lowering cholesterol concentrations can reduce coronary risk has been more limited. Hence, although many have been convinced of the clinical value of interventions to reduce cholesterol, others have remained more sceptical of the science informing such efforts. The debate has been intense, in part, because "heart" disease has a special place in the American psyche. It is the leading cause of death among Americans. In addition, the possibility of health promotion through diet has particular appeal. Interwoven with those clinical issues have been substantial economic interests and concerns. Widespread adoption of cholesterol-lowering programmes, including diet, would likely involve substantial costs to patients. Dairy and beef producers would be affected adversely, and the manufacturers of other, low-cholesterol food products would benefit. The market for safe and effective cholesterol-lowering medications, as well as tests to monitor cholesterol concentrations, could be sizable, and the revenues from the sale of such products would, in turn, be substantial. Even physicians may have a large economic stake in such interventions, because they would play an important role in administering the medications and then monitoring the patients.