The new European guidelines for prevention of cardiovascular disease are misleading

ABSTRACT

Introduction: The European Society of Cardiology and European Atherosclerosis Society (ESC/EAS) have recently published three major revisions of their guidelines for the management of chronic heart disease, blood lipids, and diabetes.

Areas covered: We have scrutinized these guidelines in detail and found that the authors have ignored many studies that are in conflict with their conclusions and recommendations.

Expert commentary: The authors of the guidelines have ignored that LDL-cholesterol (LDL-C) of patients with acute myocardial infarction is lower than normal; that high cholesterol is not a risk factor for diabetics; that the degree of coronary artery calcification is not associated with LDL-C; and that 27 follow-up studies have shown that people with high total cholesterol or LDL-C live just as long or longer than people with low cholesterol. They have also ignored the lack of exposure-response in the statin trials; that several of these trials have been unable to lower CVD or total mortality; that no statin trial has succeeded with lowering mortality in women, elderly people, or diabetics; and that cholesterol-lowering with statins has been associated with many serious side effects.

KEYWORDS:

• Cholesterol
• cardiovascular
• guidelines
• statin
• diabetes

Article highlights

• The recent European guidelines for the prevention of CVD have ignored hundreds of studies that contradict their recommendations.

• Dyslipidaemia is not the cause of atherosclerosis or CVD, neither among FH individuals nor among other people.

• Elderly patients and people with high LDL-C live just as long or longer than those with normal or low LDL-C.

• Low LDL-C is associated with increased mortality.

• Statin treatment has not exposure-response

• Statin treatment may cause many serious side effects, which more than offset the negligible benefits.

Declaration of interest

U. Ravnskov, M. de Lorgeril, M. Kendrick, H. Okuyama, and R. Sundberg have declared publishing books with criticism of the cholesterol hypothesis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.