Triple C – Doctors do like it (and economists don’t):

In the January issue we were broadcasting doctor’s dislike of vitamins. This time we are in good humour and would like to inform you about what we LIKE: triple C – that is coffee, cocoa and… cholesterol! Yes – you may trust your eyes! This is finally a positive message about western-worlds-worst-health-enemy (WWW.HE): cholesterol. Whilst the manufacturers of cholesterol-lowering-medicines (CLM – modern magazines need abbreviations) are trying to convince the public that everybody should be taking one of their fabulous pills, there is the first signs that their best customers might be dropping out.

Because: in healthy older people, higher than ‘normal’ cholesterol levels are associated with lower cardiovascular mortality in various studies. Dutch investigators have examined this issue in a prospective (as opposed to retro-spective) study involving more than 5,500 older people between the age of 55 and 99. At the start of the study mean total cholesterol level was 255 mg% (corresponding to 6.6 mmol/l) and HDL level (the “goody”) 53 mg% (corresponding to 1,37 mmol/l).

During the next 14 years no association was found between higher cholesterol and cardiovascular mortality (mainly heart-attacks and stroke ) in those aged 55 to 84. For those above the age of 84 association was even inverse – higher cholesterol predicted LOWER cardiovascular mortality! For those above the age of 65 and with a higher cholesterol there was even a lower non-cardiovascular-related mortality AND a lower cancer-related-mortality (JAMA 1994; 272:1335 + J Am Geriatr Soc 2011 Oct,; 59:1779).

Scientifically we cannot rule out that people with low cholesterol have a higher risk of suffering cancer on non-WWW.HE related problems. But we can certainly say, that cholesterol as a predictor for cardiovascular problems weakens as people get older. Practical implications will be that CLM – the ‘famous’ Statins – are unnecessary for the elderly with otherwise low coronary risk.

I can see animated 85th birthday parties with bonfires fed by prescriptions and pill-boxes: finally freee1. And if you want to be even healthier, do substitute the little round white ones with the sticky dark square ones: chocolate. Cocoa products contain polyphenols that have salutary effects on our cardiovascular system. Seven studies involving 114.000 adults between the age of 25 and 93 are included in this analysis. Chocolate consumption more than 5 times weekly was associated with significantly lower risk for any cardiovascular disease as compared to no consumption: 63 % vs. 100 % ( BMJ 2011 Aug 29; 343: d4488).

The only possible conclusion (and business idea) is that Statins should be chocolate-coated.

And last but not least: coffee. Various studies in the past have shown a lower risk for depression and even suicide with increased coffee consumption. Investigators have now studied 50.000 women who were free of depression at baseline. Coffee consumption and depression were documented during 10 years of follow up.

Risk for depression in women who drank at least 4 cups of coffee a day (American coffee!) was 20% lower than in women who drank one cup or less weekly. Decaffeinated coffee was not associated with risk reduction (Arch Intern Med 2011 Sept 26; 171:1571).

This is again, as in most scientific studies, a very limited point of view of psychiatrists. A cardiologist or gastroenterologist will almost certainly have opposing points of view in respect of the benefits of coffee drinking.

Still: it is nice to look at coffee drinking as a Mediterranean cultural habit which proves that there is reason in culture.