2013 Volume 22 Issue 1 Pages 69-76
On September 8, 2012, the panel discussion “The Rethinking of Cholesterol Issues” was held in Sagamihara City, Japan. This paper is the summary of that panel discussion. Four discussants expressed their skeptical views against the cholesterol hypothesis. The whole discussion will be freely seen on the net. Also a similar editorial written by the four discussants will be published in English (Ann Nutr Metab 2013;62:32-36, a free PDF file is already available on the internet). Because Japan Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2012 (JASG 2012) has recently been published, the main part of this paper is focused on serious flaws found in JASG 2012. Dr Harumi Okuyama discusses the differences between JASG 2012 and our guidelines indicating that high cholesterol levels are a good index of longevity; the most important point is that the statin trials that have been performed after 2004, when the new EU law regulating clinical trials became in effect, are all negative. Dr Yoichi Ogushi claims that JASG 2012 intentionally omits some good aspects of cholesterol; cholesterol is a negative risk factor of stroke. His own data also show that cholesterol is good for stroke. He also claims that to properly treat patients with diabetes, we need to reject the cholesterol hypothesis and to reduce carbohydrate rather than cholesterol. Dr Tomohito Hamazaki points out unforgivable flaws in JASG 2012. It does not disclose any COI. It does not contain any relationship between cholesterol levels and all-cause mortality in Japan. Pharmaceutical companies spend 600 billion yen (7 billion US$) per year for advertisement in Japan. This works as “devil’s insurance” (withdrawal of advertisement is a real threat to the mass media). The last discussant, Dr Rokuro Hama, explains the mistake made by JAS (liver disease causes both death and depression of cholesterol levels, and low cholesterol levels are not the cause of death). Hepatitis C virus (HCV) enters hepatic cells via LDL receptors, and low cholesterol levels are one of the major risk factors of HCV infection and chronic hepatitis. Hence, death from liver disease could be the result of low cholesterol levels.
