[Cholesterol non-consensus in primary prevention of coronary heart disease. Methodologic problems in the...

Evidence for a population intervention to lower mean serum cholesterol levels with the aim of a primary prevention of coronary artery disease and a reduction of cardiovascular mortality is critically reviewed. The arguments brought forward in favor of such interventions are frequently flawed by methodological shortcomings. Quite often, descriptive associations are taken as proofs of causal relationship--or results of prospective studies on selected cohorts are extrapolated to the general population without justification. For adolescents, women, and persons above 60 years of age (i.e., for the majority of the population) there is actually no evidence in favor of initiatives to screen for and generally lower serum cholesterol levels. Even for middle-aged men, lowering of hypercholesterolemia in an attempt of primary prevention of coronary heart disease was not followed by the expected decrease in overall mortality. A public discussion of the apparent cholesterol non-consensus is urgently needed in Germany in order to protect both the population, as well as the reputation of the medical profession against unjustified health campaigns.