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Cholesterol and Beyond : The Research on Diet and Coronary Heart Disease 1900-2000 - A. Stewart Truswell

Cholesterol and Beyond

The Research on Diet and Coronary Heart Disease 1900-2000

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Published: 29th July 2010
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"Only once in a great while does a book come along that really does the job in addressing a major medical issue. When this happens, all can be joyful... Readers will find ALL their favorite dietary puzzlements dealt with... With consummate scholarship, clarity and brevity, Truswell sifts out the chaff and identifies the critical questions, the responsible investigators, and the key studies."

So says Emeritus Professor Henry Blackburn from the University of Minnesota in the foreword to this remarkable concise book on the history of research on diet and heart disease. This was a theme of scientific, medical and public interest in the 20th Century, a century marked by the rise and fall of coronary heart disease as the major cause of death in the first world, followed by the rise of this cause of death in the developing world.

There is obviously much to learn, and this book is an excellent starting point, tracing dietary factors and their role in heart disease one by one: fats, sugar, salt, alcohol, coffee, trans-fats, etc. Without an understanding of the role of diet and the changes that have been seen in the North American and NW European diet, the story of the decline in the heart disease death rate may have been very different.

From the reviews:

"A. Stewart Truswell has written a very informative and at the same time entertaining and highly readable account of the nutritional epidemiology of CHD ... . I would strongly recommend this book ... . also be of considerable interest to epidemiologists, nutritionists, and public health scientists who are attempting to study nutrition and other diseases. ... Most importantly, this would be an extremely good book to ... research colleagues who doubt the value of good nutrition epidemiology research in the public's health." (Lewis H. Kuller, American Journal of Epidemiology, Vol. 173 (9), 2011)

Emergence of Coronary Heart Disease as a Diagnosisp. 1
In Osler's Textbook (1904)p. 1
First Reports of Coronary Thrombosis with Survivalp. 2
Papers Appear in British Journalsp. 3
Added to International List of Causes of Death (1930)p. 4
Experimental Pathology in St. Petersburgp. 5
Atherosclerosis Introduced as a Pathological Termp. 5
Pioneering Experimental Work 1908-1913 Feeding Cholesterol to Rabbits in St. Petersburgp. 5
Anitschkow Described His Work Further in 1933 American Monographp. 6
Anitschkow's Early Rabbit Work Confirmed in Other Countriesp. 7
Rabbits' Arterial Lesions Compared with Human Atherosclerosisp. 7
Is Plasma Cholesterol Raised with Human Atherosclerosis?p. 9
Cholesterol Characteristic in Human Atherosclerosisp. 9
At First not Clear if Plasma Cholesterol Raised with Human Atherosclerosisp. 9
Improved Statistical Design Shows Average Plasma Cholesterol Higher with CHDp. 10
It is Low-Density Lipoproteins that are Associated with CHDp. 10
"Normal" Cholesterol Level in Affluent Countries May not be Healthy Cholesterolp. 11
Serum Cholesterols Lower in Naples and Madrid and Hunter Gatherersp. 11
Diet can have Worth while Effects on Human Plasma Cholesterolp. 13
Dietary Cholesterolp. 13
Dietary Fat has more Effect than Dietary Cholesterolp. 14
And the Type of Dietary Fatp. 14
Saturated and Polyunsaturated Fats, Rather than Animal or Vegetable Fatsp. 14
Repeated Tests by Keys' Group with Different Fats and Oilsp. 16
Not all Saturated Fatty Acids have the same Effect on Serum Cholesterolp. 17
How does it Work? Could it be by Changing Cholesterol Excretion?p. 18
Discovery of the Low Density Lipoprotein Receptorp. 18
A New Type of Observational Epidemiologyp. 21
Invention of Prospective, Cohort Studiesp. 21
The Framingham Study, Started 1949p. 21
Results Emerge from Framingham and Subsequent Cohort Studiesp. 22
Big Three Risk Factors: Serum Cholesterol, Smoking and Blood Pressurep. 22
Tentative Recommendations to High Risk Patients Start in 1960sp. 23
Serum Triglycerides? Another Risk Factorp. 25
Endogenous and Exogenous Serum Triglyceridesp. 25
Early Claims that Serum Triglycerides Predict Risk of CHDp. 25
Fasting Serum Triglycerides not a Strong Independent Risk Factorp. 26
Fredrickson's Classification of the Hyperlipoproteinaemiasp. 29
Five Types of Hyperlipidaemia, and Three Types of Low Serum Lipoproteinsp. 29
Further Developments of Fredrickson's Typesp. 31
The Seven Countries Study (7CS)p. 33
Setting Upp. 33
Methodsp. 35
Resultsp. 35
Dietary Resultsp. 36
Implications from the 7CSp. 37
Longer Follow Upp. 38
Sucrose - An Alternative Dietary Hypothesisp. 39
Yudkin's Proposalp. 39
Reactionsp. 40
HDL-Cholesterol is Protectivep. 41
Early Observationsp. 41
The Millers' Hypothesisp. 42
It Ran Against the Grainp. 42
Epidemiological Supportp. 42
HDL2 or HDL3?p. 43
In Developing Countries?p. 43
In Womenp. 43
Diet Affects HDL-Cholesterol Quite Differentlyp. 44
Critics and Scepticsp. 45
Sir John McMichael, Londonp. 45
Dr George Mann, USAp. 46
Thrombosis on and in Atheromap. 49
Thrombosis a Separate, Acute Processp. 49
Tests for Liability to Thrombosis are Indirectp. 49
Or can Mural Thrombosis Become Atheroma?p. 50
Dietary Cholesterol May Affect Plasma Cholesterolp. 51
Keys had Asserted Dietary Cholesterol does not Raise Plasma Cholesterolp. 51
Other Early Studies Inconclusivep. 51
Keys' Group and Hegsted's Group Re-examinep. 52
Metabolism of Labelled Cholesterolp. 52
Many Human Experiments with Dietary Cholesterol 1960s and 1970sp. 53
Are some Individuals Responsive to Dietary Cholesterol, not Others?p. 54
Effect of Basal Cholesterol Intakep. 55
Different Recommendations by Advisory Committesp. 56
First Controlled Trialsp. 57
First Two Randomised Dietary Trials, 1965p. 57
Two more Dietary Trialsp. 58
The Los Angeles VA Trial, Reported 1969p. 59
Helsinkin Mental Hospitalsp. 59
Drugs Trialsp. 61
Early Trials with Cholesterol-Lowering Drugsp. 61
More Promising Drugs Followedp. 61
"Atromid" or Clofibratep. 62
Cholestyramine Resinp. 62
Dietary Fibrep. 63
Obesityp. 65
Desirable Weight for Heightp. 65
Body Mass Indexp. 66
Waist Circumference - Visceral Adiposityp. 69
At the End of the Century the Cardiac Risk of Overweight Remained Variable for Moderate Overweightp. 70
Thrombosis Treated Earlyp. 71
Acute Phase Coronary Angiographyp. 71
Clotting Factors in a Prospective Studyp. 72
Platelet Functionp. 73
What's a Normal Plasma Cholesterol?p. 74
Fish Oilp. 77
Traditional Eskimos: High Fat Diet but CHD Uncommonp. 77
Eicosapentaenoic Acid Reduces Platelet Aggregationp. 78
Epidemiological Studies: Fish Consumption and CHDp. 79
Polyunsaturated Oils Prevent Dangerous Arrhythmias in Ratsp. 80
Human Prevention Trials with Fish Oilp. 81
Alcoholp. 83
Impressions at Post-mortem Examinationp. 83
Negative Association with CHD in 1974 Case-Control Studyp. 84
Epidemiological Studies Build Up the Casep. 84
Alcohol Only Benefits Health of Older People in Developed Countriesp. 86
Which Type of Alcoholic Drink?p. 87
How does Alcohol Reduce the Risk of CHD?p. 88
Serum HDL-Cholesterol (HDL-c)p. 88
Haemostatic Effectsp. 89
Polyphenolic Antioxidants in the Beveragep. 89
The French Paradoxp. 89
Coffeep. 91
Coffee and Caffeinep. 91
Coffee and CHD (Direct) Epidemiologyp. 92
Coffee and Serum Cholesterol: Human Experimentsp. 93
It's Cafestol and Kahweol in Coffee that Raise Serum Cholesterolp. 94
And Tea?p. 95
Trans-Fatty Acidsp. 97
Hydrogenation of Liquid Oils to make Solid Margarinesp. 97
Human Experiments: Trans Fatty Acids and Serum Cholesterolp. 98
Epidemiological Studiesp. 101
Conclusionp. 102
Antioxidantsp. 103
LDL Oxidation and Atherosclerosis - Hypothesisp. 103
¿-Tocopherol the Major Antioxidant Inside LDLp. 104
Vitamin E and CHD in Cohort Studiesp. 104
Randomised Controlled Prevention Trials with Vitamin Ep. 105
Trials with Beta-Carotenep. 105
Why didn't Alpha Tocopherol or Beta Carotene Work?p. 106
Fruit and Vegetables - Part of Favourable Dietary Patternsp. 106
More Controlled Dietary Trialsp. 109
Further Dietary Trials in Table 23.1p. 109
Two Large Multi-Factorial Trialsp. 112
Four Dietary Trials Assessed by Coronary Angiographyp. 113
The Lyon Diet Heart Studyp. 114
Trials of Better Drugsp. 115
Cholestyramine (1984)p. 115
Gemfibrozil (1987)p. 116
Statins Arrivep. 116
Implications of Statinsp. 118
Linoleic Acid is Protectivep. 121
Cohort Studies Accumulatep. 121
Mechanism(s) of Actionp. 123
Linoleic (18:2) not the Usual Source of Arachidonic Acid (20:4)p. 123
Recommendationsp. 123
Plant Sterols Fade and Returnp. 125
Phytosterols not Absorbedp. 125
The Pharmaceutical Phasep. 126
Sitosterolaemiap. 127
The Food Additive Phasep. 127
Soy Proteins Versus Caseinp. 129
An Animal Protein Effect on Serum Cholesterol in Rabbitsp. 129
In Humans Soy Protein Compared Against Casein: Variable Resultsp. 130
Isoflavones may Contributep. 131
High Homocysteine Associated with Cardiovascular Diseasesp. 133
Homocystinuria and Arterial Diseasep. 133
Raised Plasma Homocysteine and Arterial Diseasep. 134
Environmental Influences on Plasma Homocysteinep. 135
Plasma Homocysteine Lowered by Folic Acid and/or Vitamin B-12p. 136
And Salt should be Includedp. 139
Discovery of Essential Hypertensionp. 139
Early Diets for Hypertensionp. 140
Is Salt a Cause of Essential Hypertension?p. 142
Thiazides and Scepticsp. 144
Potassium and Blood Pressurep. 144
Answers to the Sceptics; the Salt Case Developsp. 145
Moderate Sodium Restrictionp. 145
Remote Communitiesp. 146
Regression Dilution Biasp. 147
Intersaltp. 147
Chimpanzee Experimentsp. 148
Cardiac Effects of Salt Reductionp. 149
Higher Blood Pressures in African Americansp. 149
Baby Food Manufacturers take the Leadp. 150
And for Adultsp. 151
Dietary Goals for the USp. 151
Subsequent Official Recommendationsp. 152
Most Salt we Eat was Put in by Food Processorsp. 152
How does BP Increase in Salt-Sensitive Individualsp. 153
Kidneysp. 153
Arteriolesp. 153
Humoral Inhibitor of the Sodium Pumpp. 154
Into the Next Centuryp. 155
How it Adds Upp. 157
American Heart Association, 2000p. 157
In "ABC of Nutrition", 1999p. 158
The Big Picturep. 161
USA and Canadap. 161
Australia and New Zealand (Fig. 31.4)p. 164
Nordic Countriesp. 166
British Isles (Fig. 31.6)p. 167
Western Europep. 168
East European Countriesp. 169
End Notesp. 173
What Happenedp. 173
On the Research Frontp. 174
Inertia and Oppositionp. 175
In the Public Arenap. 176
What Happened Furtherp. 177
Hypothesis and Variationsp. 178
Referencesp. 181
Indexp. 221
Table of Contents provided by Ingram. All Rights Reserved.

ISBN: 9789048188741
ISBN-10: 9048188741
Audience: Professional
Format: Hardcover
Language: English
Number Of Pages: 227
Published: 29th July 2010
Publisher: Springer
Country of Publication: NL
Dimensions (cm): 23.5 x 15.5  x 1.91
Weight (kg): 1.15