Book Review: Modern Methods in Pharmacology, Vol 2
J S Gillespie · Journal of the Royal Society of Medicine · 1985
New York: Alan R Liss 1984Attitudes towards the management of patients with coronary artery disease differ substantially between those whose primary interest is in community health and those who manage such patients every day.Despite the exhortations ofepidemiologists and numerous august bodies, many clinicians have been reluctant to advise patients to adhere to rigid, tiresome and often difficult health schedules.The reasons for this difference of opinion are readily apparent.Physicians, the media and the public are aware that coronary artery disease is common in the western world, is more common in those countries with a high intake of lipids, is declining in America, is associated with certain risk factors, declined during the war years, can be induced in animals, and does occur in families with known inherited lipid abnormalities.Less well known are the uncomfortable facts that the diet hypothesis for coronary artery disease is not easily sustained in several countries, such as Sweden, Israel and Switzerland, and that numerous large epidemiological studies aimed at reducing the incidence of coronary artery disease, the MRFIT Study, the WHO European Study, the North Korelia Study, the WHO (clofibrate study), and the Lipid Research Clinics Study, failed to show any great benefit to patients.Two of these studies, the WHO (clofibrate study) and the Lipid Research Clinics Study, did show that reducing the cholesterol in a high-risk group of patients brought about a fall in the incidence of coronary artery disease; total mortality was either increased or unchanged.Numerous reasons have been put forward for these negative results, but perhaps the most persuasive is that the trials were undertaken for too short a period of time and initiated in too old a population when disease was already established.An alternative possibility is that the scientific ideas upon which the trials were based are in error.For example, it may be that certain types of fat, yet to be clearly identified, and certain particular abnormalities of lipid metabolism favour the progression of coronary artery disease.This long book reports the proceedings of a workshop held in the United States of America in August 1983.A number of population studies are discussed including the Tecumseh Study, the Denver Heart Study and the Framingham Heart Study.The main thrust of the meeting was to