The document discusses the myth that a high-fat diet leads to high cardiac mortality, noting that the original study supporting this claim selectively used data from only 6 countries. Several large prospective studies are summarized that find no association between saturated fat consumption and heart attack risk, and some find lower cardiac mortality rates associated with higher fat intake. The "truth" discussed is that cholesterol and high fat diets are not actually causes of cardiac problems, but this view is not widely publicized due to pharmaceutical industry influence.

1. Cholesterol and
Cardiac Mortality
Myth & Truth
Fayza Rayes
MBBCh. Msc. MRCGP
Consultant Family Physician
Joint Program of Family & Community Medicine, Jeddah
www.fayzarayes.com

2. The Myth
People consume high fat diet have
high cardiac mortality

3. The Original Evidence Ancel Keys cheated.
He selected data from 6
countries to create the
linear relationship.
Data were actually
available from total of
22 countries!
This is the graph of heart deaths Keys (1953). Journal of mount
Sinai Hospital New York
plotted against fat intake

4. Consumption of fat and cardiac mortality
We can make it a
straight line, it
shows very clear
positive
correlation:

5. Consumption of fat and cardiac mortality
Choosing a few
other countries
might have
given a
negative
correlation:

6. Consumption of fat and cardiac mortality
Choosing a few
other countries
the negative
correlation
become more
clear
(consumption of
>40% of
calories from fat
associated with
lower cardiac
mortality):

7. Consumption of fat and cardiac mortality
So let's look at
the whole
database from
which Keys
carefully selected
his six countries

8. Consumption of fat and cardiac mortality
Cmpare to the original
line swept in by Keys.
Things get worse if
you add in the Masai,
the Inuit, the Rendile,
the Tokelau and a few
others, shown as red
dots:

9. Cholesterol and Cardiac Mortality
Other Studies
Do people who eat more saturated fat have more heart attacks?
The following are high-impact prospective studies, showing no
association between saturated fat consumption and heart attack risk.

10. Cholesterol and cardiac mortality
Between nation
studies this figure,
credited to Dr.
Kendrick, shows
the rates of death
from CHD plotted
against the percent
of a given
population who are
frankly
hypercholesterola-
-emic. He
extracted the data
from MONICA
study

11. Negative
Correlation
WHO-MONICA Study- Multinational MONItoring of Trends and
determination in CArdiovascular Disease; a 10 year study, 7
million people,14 European countries plus the Australian
Aborigines (Aborigines are the leftmost country-lowest
cholesterol & highest death rate).

12. BMJ. 1996 Jul 13;313(7049):84-90.
Dietary fat and risk of coronary heart disease in
men: cohort follow up study in the USA
Ascherio A, Rimm EB, Giovannucci EL, Spiegelman D, Stampfer
M, Willett WC.
Source: Harvard School of Public Health, Boston, MA 02115, USA.
OBJECTIVE: To examine the association between fat intake and the
incidence of coronary heart disease in men of middle age and older.
DESIGN: Cohort questionnaire study of men followed up for six years
from 1986.
SETTING: The health professionals follow up study in the United States.
SUBJECTS: 43 757 health professionals aged 40 to 75 years free of
diagnosed cardiovascular disease or diabetes in 1986.
MAIN OUTCOME MEASURE: Incidence of acute myocardial infarction or
coronary death.

13. RESULTS: During follow up 734 coronary events were
documented, including 505 non-fatal myocardial infarctions and 229
deaths. After age and several coronary risk factors were controlled for
significant positive associations were observed between intake of
saturated fat and risk of coronary disease. For men in the top versus
the lowest fifth of saturated fat intake (median = 14.8% v 5.7% of
energy) the multivariate relative risk for myocardial infarction was 1.22
(95% confidence interval 0.96 to 1.56) and for fatal coronary heart
disease was 2.21 (1.38 to 3.54). After adjustment for intake of fibre
the risks were 0.96 (0.73 to 1.27) and 1.72 (1.01 to 2.90), respectively.
Positive associations between intake of cholesterol and risk of
coronary heart disease were similarly attenuated after adjustment for
fibre intake. Intake of linolenic acid was inversely associated with risk
of myocardial infarction; this association became significant only after
adjustment for non-dietary risk factors and was strengthened after
adjustment for total fat intake (relative risk 0.41 for a 1% increase in
energy, P for trend < 0.01).

14. CONCLUSIONS: These data do not support
the strong association between
intake of saturated fat and risk of
coronary heart disease suggested by
international comparisons. They are compatible,
however, with the hypotheses that saturated fat
and cholesterol intakes affect the risk of coronary
heart disease as predicted by their effects on
blood cholesterol concentration. They also
support a specific preventive effect of linolenic
acid intake.

15. J Intern Med. 2005 Aug;258(2):153-65.
Dietary fat intake and early mortality patterns--data from
The Malmö Diet and Cancer Study.
Leosdottir M, Nilsson PM, Nilsson JA, Månsson H, Berglund G.
Source : Department of Medicine, Lund University, University Hospital (UMAS),
Malmö, Sweden. margret.leosdottir@med.lu.se
OBJECTIVES: Most current dietary guidelines encourage limiting relative fat
intake to <30% of total daily energy, with saturated and trans fatty acids
contributing no more than 10%. We examined whether total fat intake,
saturated fat, monounsaturated, or polyunsaturated fat intake are
independent risk factors for prospective all-cause, cardiovascular and cancer
mortality.
DESIGN: Population-based, prospective cohort study.
SETTING AND SUBJECTS: The Malmö Diet and Cancer Study was set in the
city of Malmö, southern Sweden. A total of 28,098 middle-aged individuals
participated in the study 1991-1996.
MAIN OUTCOME MEASURES: Subjects were categorized by quartiles of
relative fat intake, with the first quartile used as a reference point in
estimating multivariate relative risks (RR; 95% CI, Cox's regression model).
Adjustments were made for confounding by age and various lifestyle factors.

16. RESULTS: Women in the fourth quartile of total fat intake had a
significantly higher RR of cancer mortality (RR 1.46; CI 1.04-2.04). A
significant downwards trend was observed for cardiovascular
mortality amongst men from the first to the fourth quartile (P=0.028).
No deteriorating effects of high saturated fat intake were observed for
either sex for any cause of death. Beneficial effects of a relatively high
intake of unsaturated fats were not uniform.
CONCLUSIONS: With the exception of cancer mortality for women,
individuals receiving more than 30% of their total daily energy from fat
and more than 10% from saturated fat, did not have increased
Current dietary guidelines
mortality.
concerning fat intake are thus generally
not supported by our observational
results.

17. The Truth
People consume high fat diet and people
with high serum cholesterol have
low cardiac mortality

18. But Why ??!!
 Why cholesterol has received plenty of this
negative media over the last decade?
 Several studies have shown that cholesterol is
not the cause behind problems of the heart.
 The reason is crystal clear: The pharmaceutical
companies who manufacture cholesterol-
lowering drugs have protected their billions of
dollars by twisting the information.

19. The Bitter Truth
$ billion
Year
During the past decade Pfizer's Lipitor generated
$115 billion in cumulative global revenue

20. For More Information
 Go to: http://fayzarayes.com
 Or go to YouTube
http://www.youtu.be/cmwNpUJUjPg
Big Fat Fiasco pt. 1-5