The Cholesterol Wars: The Cholesterol Skeptics vs the Preponderance of Evidence

Abstract

Daniel Steinberg 227 pages. New York, NY: Academic Press; 2007. $69.95. ISBN 978-0123739797 I consider The Cholesterol Wars by Daniel Steinberg to be required reading for every serious student of atherosclerosis and lipidology. It is written in an authoritative, scholarly, yet readable style. Steinberg has carefully reviewed the material for which he previously laid the groundwork with a series of articles in the Journal of Lipid Research . His subject is one about which he knows a great deal and in which he himself played a major role over the last 5 decades. I remember first hearing him speak about the subject matter of the book during the 2001 Drugs Affecting Lipid Metabolism meeting during a dinner at the Russian Tea Room in New York the night before 9/11. Everyone present that night remembers both the scintillating talk as well as where they were on that particular occasion. I will make a few comments, observations, and an occasional critical remark that is not intended to detract from the quality of this publication. First, Steinberg begins by discussing the early cholesterol-feeding experiments of Nikolai Anitschkow and rightly points out that they followed studies on the toxicity of feeding large amounts of protein to rabbits. I believe that part of the failure to accept the cholesterol hypothesis on the basis of Anitschkow’s work is related to the extreme conditions of the experiment and to the very high levels of cholesterol obtained in the blood, which raised doubts about its relevance to humans. We now know with the benefit of hindsight that one can develop atherosclerosis even with lesser degrees of cholesterol elevation, but many also suspected that the cholesterol-feeding experiments might have induced an inflammatory response that was separate …