Cholesterol versus inflammation as cause of chronic diseases

Tsoupras and colleagues have postulated, in a recent review in Nutrients, that the key to reducing the incidence of cardiovascular disease is to control the activities of inflammatory mediators such as platelet-activating factor (PAF) by diet, exercise, and healthy lifestyle choices. We agree with this sensible conclusion, which is based on the extensive scientific literature. The authors argue that their proposal is contrary to the lipid (or cholesterol) hypothesis. This supposes that the reduction of plasma lipid concentrations will reduce new incidents of cardiovascular disease, a concept developed over many decades from the recommendation in 1976 that a combined drug/diet regimen in a study with large numbers of male hyperlipidemic subjects would be necessary to test the accuracy of the hypothesis. Following extensive studies with the statins as lipid-lowering drugs, the accumulation of evidence for the lipid hypothesis was then presented in 2006 with Steinberg concluding that the controversy was solved by the results of these studies, stating that "The cholesterol controversy could have been resolved much earlier if all of us had looked at all of the evidence". However, this conclusion on the lipid hypothesis continues to arouse passionate arguments, as shown in the review by Tsoupras and colleagues [1] and in other recent reviews.