In the letters section in the British Medical Journal BMJ 2002;325:1114 ( 9 November ) a response by Malcolm Kendrick, medical director. Adelphi Lifelong Learning, Adelphi Mill, Bollington, Macclesfield SK10 5JB malcolm@llp.org.uk states the following:
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Can Law and Wald fit these figures onto their semilogarithmic scale? The suggestion that no levels of any risk factor in the Western world are currently normal, and that what we call a normal blood pressure is actually high and should be lowered, is dangerous nonsense.

Are Law and Wald aware of data from Framingham, which show that falling cholesterol concentrations are directly associated with an increased risk of coronary heart disease?3 Are they aware of research from Japan that shows a completely inverse relation between rising cholesterol concentrations and deaths from coronary heart disease?4 Hundreds of papers contradict the association between raised cholesterol concentrations and death from coronary heart disease.

Shestov in his lipid clinics study in Russia even showed an inverse relation, with higher rates of coronary heart disease in patients with hypocholesterolaemia. The Honolulu study shows that, in people older than 50, a low cholesterol concentration is by far the most important risk factor for premature death.5 Law and Wald did not show one curve relating to cholesterol loweringthe J shaped curve of total mortality with 5.2 mmol/l at the bottom of that curve (figure).
Law and Wald are effectively suggesting that there is no non-dangerous blood pressure or cholesterol concentration and that, therefore, almost everyone in the Western world should be given some kind of drug treatment. This is dangerous nonsense, and we should not be afraid to say so. Malcolm E Kendrick, medical director. Adelphi Lifelong Learning, Adelphi Mill, Bollington, Macclesfield SK10 5JB malcolm@llp.org.uk

1.
Law MR, Wald NJ. Risk factor thresholds: their existence under scrutiny. BMJ 2002; 324: 1570-1576. (29 June.)2.
Law MR, Wald NJ. Why heart disease mortality is low in France: the time lag explanation [with commentaries by M Stampfer, E Rimm, D J P Barker, J P Mackenbach, and A E Kunst]. BMJ 1999; 318: 1471-1480[Free Full Text].3.
Anderson KM, Castelli WP, Levy D. Cholesterol and mortality: 30 years of follow-up from the Framingham study. JAMA 1987; 257: 176-180.4.
Okayama A, Ueshima H, Marmot MG, Nakamura M, Kita Y, Yamakawa M. Changes in total serum cholesterol and other risk factors for cardiovascular disease in Japan 1980-1989. Int J Epidemiol 1993; 22: 1038-1047[Abstract/Free Full Text].5.
Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD. Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study. Lancet 2001; 358: 351-355[CrossRef][ISI][Medline].
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The point being High Cholesterol is NOT the bad guy its made out to be. Read these statements again:
"...data from Framingham, which show that falling cholesterol concentrations are directly associated with an increased risk of coronary heart disease?3 "

"...research from Japan that shows a completely inverse relation between rising cholesterol concentrations and deaths from coronary heart disease?4"

"Hundreds of papers contradict the association between raised cholesterol concentrations and death from coronary heart disease."

"The Honolulu study shows that, in people older than 50, a low cholesterol concentration is by far the most important risk factor for premature death.5"