Cholesterol: the Stigma Is Back

New report reaffirms the link to heart disease

When the Food and Nutrition Board of the National Academy of Sciences reported last spring that healthy adults should not be unduly worried about cholesterol in their diets, boosters of cholesterol-rich foods were gleeful. At last the stigma attached to beef, eggs and junk fare seemed to be lifting. But last week cholesterol's reputation as a major factor in heart disease was buttressed with the publication of a 20-year epidemiological survey of middle-aged American men.

The study, conducted by scientists at Chicago's Rush-Presbyterian-St. Luke's Medical Center and at Harvard, Northwestern and the University of Michigan, involved 1,900 men recruited in 1957 from Western Electric Co.'s Hawthorne Works plant near Chicago. Then aged 40 to 55. the subjects were questioned in detail about their diets and personal habits. Using a checklist of 195 foods, researchers determined what and how much the men had eaten in the preceding 28 days. The participants' wives and employees at the company cafeteria were asked how food was prepared. Each subject was rated low, middle or high according to his intake of cholesterol, saturated fat (found in red meats and dairy products) and polyunsaturated fat (vegetable oils).

Twenty years later, the scientists tracked down the participants. The main finding: those who had consumed large amounts of cholesterol and saturated fat suffered upwards of a third more deaths from heart disease than those who consumed relatively small amounts. Says Epidemiologist Richard Shekelle of Rush-Presbyterian-St. Luke's, author of the report in the New England Journal of Medicine: "If you look at the weight of the evidence over the years, then our study reinforces the conclusion that dietary cholesterol affects the level of cholesterol in the blood and increases the risk of heart disease."

Nevertheless, the report is unlikely to halt debate over cholesterol. Critics of the diet-heart link point out that the body manufactures most of the cholesterol found in the blood. Thus even the most careful diet will have only a limited effect on cholesterol levels. The Chicago survey also failed to take into account changes in the intervening 20 years that could have affected the development of heart disease. Notes Peyton Davis of the National Live Stock and Meat Board: "Not only diet could change, but also the amount of alcohol a man consumes, the amount he smokes and how much exercise he gets."

Shekelle acknowledges that it "would be reasonable to assume" that many Hawthorne Works employees did change their diets. "Americans as a whole have reduced the amount of cholesterol they take in," he says. "But I would say our study probably underestimates the effect of diet. Most of our subjects were 'meat and potatoes' men. Practically no one had what could be called a low-fat diet."

His recommendation: "The 'prudent diet' should be followed by people who are concerned about heart disease. That means decreasing the amount of fats and cholesterol."

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