Saturated fat role in heart disease 'a myth'

The importance of eating less saturated fat to reduce the risk of heart disease is a 'myth' and reducing sugar intake to avoid obesity would have a far greater benefit, a cardiologist has said.

Heart attack: Statins are 'overprescribed', cardiologist warns

Dr Aseem Malhotra, an interventional cardiology specialist registrar at Croydon University Hospital in London, said the government’s 'obsession' with dietary levels of total cholesterol has led to overmedication of millions of people with statins.

The British Heart Foundation said evidence for the effect of diet on cardiovascular risk was mixed but that statins could benefit some patients.

Writing in a BMJ opinion article, Dr Malhotra said the 'mantra' of cutting total cholesterol had diverted attention from the more serious risk factor of imbalances in blood cholesterol.

Lowering total LDL cholesterol by cutting out saturated fat only affects large, 'type A' fat particles, when it is smaller, dense 'type B' particles, linked to carbohydrate intake, that can cause cardiovascular disease, he said.

Yet, the concern over total cholesterol levels prompted dietary advice encouraging people to eat foods with less saturated fat. But this has led the food industry to replace it with more sugar.

This dietary shift has contributed to a surge in obesity, Dr Malhotra said. Over the past 30 years in the US, he said, the proportion of energy from fat has fallen from 40% to 30%, 'yet obesity has rocketed'.

Furthermore, studies have failed to show that low cholesterol can reduce cardiovascular and non-cardiac mortality, suggesting high total cholesterol 'is not a risk factor in a healthy population', Mr Malhotra said.

'Time to bust the myth'

He also questioned the benefits of widespread statin use, saying research shows eating a Mediterranean diet after a heart attack is 'almost three times as powerful in reducing mortality as taking a statin'.

He concluded: 'It is time to bust the myth of the role of saturated fat in heart disease and wind back the harms of dietary advice that has contributed to obesity.'

Hertfordshire GP Professor David Haslam, chair of the National Obesity Forum said: 'It's extremely naive of the public and the medical profession to imagine that a calorie of bread, a calorie of meat and a calorie of alcohol are all dealt with in the same way by the amazingly complex systems of the body.

'The assumption has been made that increased fat in the bloodstream is caused by increased saturated fat in the diet, whereas modern scientific evidence is proving that refined carbohydrates and sugar in particular are actually the culprits.'

'Evidence unclear'

But the British Heart Foundation's medical director, Professor Peter Weissberg, said research on the link between diet and heart disease had produced conflicting results.

'However, people with highest cholesterol levels are at highest risk of a heart attack and it’s also clear that lowering cholesterol, by whatever means, lowers risk,' he said.

'Cholesterol levels can be influenced by many factors including diet, exercise and drugs, in particular statins. There is clear evidence that patients who have had a heart attack, or who are at high risk of having one, can benefit from taking a statin. But this needs to be combined with other essential measures, such as eating a balanced diet, not smoking and taking regular exercise.'

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