Benecol - Healthcare Professionals

Epidemiology

The relationship between the level of cholesterol and the risk of coronary disease was first established by the MRFIT study (Stamler J et al. JAMA. 1986;256:2823-8). These data show a substantial curvilinear increase in risk over the entire cholesterol range. Studies across different populations from seven countries on different continents reveal an identical relation, i.e., that populations with higher cholesterol levels all have more atherosclerosis and CHD than do those with lower levels (Verschuren et al. J Am Med Assoc. 1995;274(2):131-6). Even in those populations with very low average cholesterol levels, such as Asians, LDL-C discriminates fairly well between high- and low-risk individuals (Chen Z et al. BMJ. 1991;303:276-82). Furthermore, there is no doubt that LDL-C levels are associated with a greater risk if triglycerides are raised and/or HDL-C is low. The same relation holds for recurrent coronary events in people with established CHD. Any LDL-C above 100 mg/dl (2.5 mmol/l) appears to be atherogenic.

The capacity of elevated LDL-C to cause CHD is most clearly shown in patients with hereditary forms of hypercholesterolaemia (Brown MS and Goldstein JL. Science. 1986;232:34-47). In these individuals, atherosclerosis can usually first be identified by gross pathological examination of coronary arteries in adolescensce or early childhood. The subsequent rate of atherosclerosis is proportional to the severity of environmental risk factors, including serum cholesterol levels. Moreover, the cholesterol level in young adulthood predicts development of CHD later in life. By contrast, LDL-C as low as 25-60 mg/dl (0.6-1.5 mmol/l) is physiologically sufficient and well tolerated. Moreover, persons who have low levels of LDL-C throughout life due to genetic variations are proven to have a low prevalence of CHD (Cohen J et al. N Engl J Med. 2006;354:1264-72) and are long-lived (Glueck CJ et al. J Lab Clin Med. 1976;88:941-57).