The U and heart disease: Missed a beat

  • Article by: PAUL JOHN SCOTT
  • Updated: April 19, 2011 - 8:56 PM

Researchers don't always get it right, and Ancel Keys is a case in point.

Photo: Hector Casanova, Mct

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When it comes to the business of health care, Minnesota has no shortage of self-esteem.

Taking stock of our gleaming hospitals, medical research and heart device companies, we stand convinced that Minnesota has helped to make America healthier and its health care system more effective.

But boosterism can leave us blind to the ways in which, when it comes to heart disease, Minnesota has done quite a bit to mess things up.

In fact, one could argue that Minnesota-based research has its fingerprints on the most damaging wrong turn ever taken in how we think about cardiovascular illness, a mistake that continues to cost our nation in sickness and in dollars, and one for which health authorities remain too embarrassed, confused, blinded by ideology or loyalty to tribe to concede.

We told the world that heart disease is caused by elevated cholesterol and that reducing saturated fat in the diet reduces this risk. That led the country to embrace the lowering of cholesterol with medications.

All of those assumptions have proven themselves to be either overstated, oversimplified or wrong, and that has led us astray. Would it be too much for the leading cardiologists in our community to admit as much?

"It was also nearly 60 years ago," as Dr. Daniel J. Garry extolled on these pages ("Treating heart disease at the U: A story of steady innovations," April 14), "that University of Minnesota scientists -- Dr. Ancel Keys along with Drs. Francisco Grande and Joseph Anderson -- defined the relationship between dietary fat and serum cholesterol, which linked cholesterol to heart disease."

Garry went on to praise the creation of cholesterol-lowering drugs that stemmed from Keys' work.

Keys constructed his hypothesis after studying the diets and heart disease in countries across the globe.

But his research left out nations with data that did not match the hypothesis, and even within the data he published, populations existed in which diet and heart disease were wildly out of synch with his model.

By 1970, an English researcher named John Yudkin would argue that sugar in the diet was the cause of heart disease in wealthy nations, but Keys, sensing that his theory was suddenly vulnerable to reconsideration, aggressively led the charge to have that research discredited.

Today, the low-fat advice that ensued from Keys' research is seen as having had a blowback. It caused a rise in our consumption of refined carbohydrates and added sugars, thereby causing metabolic syndrome characterized by a rise in triglycerides and a lowering of HDL, or good cholesterol.

Statins lower LDL, or "bad cholesterol," and thanks to Keys, the lowering of LDL has become "the primary focus of preventive medicine in the United States," in the words of Dr. John Abramson, author of "Overdosed America."

In the last 10 years, Americans have spent $144 billion on statins in this country, and as of 2006, often with the help of a Medicare drug benefit paid for on the national credit card.

One wonders if the seniors who make up so much of the Tea Party movement realize the billions they have added to the debt with their Lipitor.

Garry extolled the ability of statins to reduce heart attacks by 60 percent, but did not mention that this is a relative benefit -- in the healthy, you have to give the drug to thousands of people to prevent a small number of episodes.

For those with no heart disease, the drugs do not extend life at all. Moreover, where heart disease exists, the effectiveness of statins may have little to do with their ability to lower LDL cholesterol but rather with their ability to reduce inflammation.  

Finally, if statins do work by way of lowering LDL, they make for a sloppy drug:  LDL comes in large and small varieties, and only the smaller forms are implicated in heart disease. (And they are raised by carbohydrates in the diet, not fat -- another Keys error.)

According to a study published last year in the Texas Heart Institute Journal, while they reduce all forms of LDL, statins end up increasing the percentage of smaller forms. In other words, they are an expensive class of drugs that helps a few, by targeting the wrong compound.

"Truly, cardiovascular research is one of Minnesota's inspiring success stories," Dr. Garry concluded, and when it comes to surgical interventions, that may indeed be the case.

But when it comes to ideas about diet and health, perhaps the university's new cardiology center could take some advice from a recent article by David Freedman in the Atlantic Monthly about the frequency of errors in scientific research.

"We could solve much of the wrongness problem," Freedman writes, "if the world simply stopped expecting scientists to be right. That's because being wrong in science is fine, and even necessary -- as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough."

Paul John Scott is a health and fitness writer whose work has appeared in Men's Health, the New York Times and Details. He lives in Rochester.

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