Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jul 26, 2015; 7(7): 404-409
Published online Jul 26, 2015. doi: 10.4330/wjc.v7.i7.404
Cholesterol confusion and statin controversy
Robert DuBroff, Michel de Lorgeril
Robert DuBroff, Department of Medicine, Division of Cardiology, University of New Mexico School of Medicine, MSC 10-5550, 1 University of New Mexico, Albuquerque, NM 87131, United States
Michel de Lorgeril, PRETA-TIMC-IMAG, Equipe Cœur and Nutrition, CNRS UMR 5525-UJF-INP, Faculté de Médecine, Domaine de la Merci, Université de Grenoble, 38700 La Tronche, France
Author contributions: DuBroff R reviewed the literature, composed and wrote the article; de Lorgeril M made suggestions, provided literature, reviewed the article and guided the initial submission and revision process.
Conflict-of-interest statement: DuBroff R does not disclose any conflict of interest; de Lorgeril M discloses receiving research grant (through Grenoble University School of Medicine) from the European Community and from the Barilla G and R F.lli Company.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Michel de Lorgeril, MD, PRETA-TIMC-IMAG, Equipe Cœur and Nutrition, CNRS UMR 5525-UJF-INP, Faculté de Médecine, Domaine de la Merci, Université de Grenoble, 38700 La Tronche, France.
Telephone: +33-476-637471 Fax: +33-476-637152
Received: February 24, 2015
Peer-review started: February 26, 2015
First decision: March 20, 2015
Revised: April 9, 2015
Accepted: April 28, 2015
Article in press: April 30, 2015
Published online: July 26, 2015

The role of blood cholesterol levels in coronary heart disease (CHD) and the true effect of cholesterol-lowering statin drugs are debatable. In particular, whether statins actually decrease cardiac mortality and increase life expectancy is controversial. Concurrently, the Mediterranean diet model has been shown to prolong life and reduce the risk of diabetes, cancer, and CHD. We herein review current data related to both statins and the Mediterranean diet. We conclude that the expectation that CHD could be prevented or eliminated by simply reducing cholesterol appears unfounded. On the contrary, we should acknowledge the inconsistencies of the cholesterol theory and recognize the proven benefits of a healthy lifestyle incorporating a Mediterranean diet to prevent CHD.

Keywords: Cholesterol, Statins, Coronary heart disease, Mediterranean diet, Cardiovascular disease, Mortality

Core tip: Traditional efforts to prevent cardiovascular disease have emphasized the benefits of cholesterol lowering and statin drugs. Often overlooked is the fact that numerous studies of cholesterol lowering have failed to demonstrate a mortality benefit and the benefits of statins may have been overstated. The Mediterranean diet has consistently lowered cardiovascular events and mortality in numerous studies and does not typically lower cholesterol levels. Alternative theories of atherosclerosis are independent of cholesterol metabolism and may provide the key to future preventive strategies.