Day 252 - 20 May 96 - Page 23


     
     1        A.   From its present level.
     2
     3   Q.   And I think you said that it had decreased since
     4        recommendations were initially made 20 years ago?
     5        A.   Yes, it has over the last ten years decreased because,
     6        although the public became aware that in 1974 the
     7        recommendation was to reduce cholesterol, and particularly
     8        to reduce egg consumption, as I said, egg consumption has
     9        now been halved and the result is that the average level of
    10        blood cholesterol in the British population has fallen
    11        significantly and now it has become responsive to an
    12        increase in dietary cholesterol, which it did not do
    13        before.
    14
    15   Q.   Because it was--
    16        A.   Simply because it is not a dose related response that
    17        above a certain level of increase further increases have no
    18        effect on the cholesterol.  So we have now achieved
    19        something, we have lowered cholesterols significantly, and
    20        the idea is to hold them at that level and not allow them
    21        to increase again.
    22
    23   Q.   Right.  And you want to hold them at that level because of
    24        the health risks?
    25        A.  Yes, yes.  Well, because of a risk of the mean blood
    26        cholesterol beginning to rise again and thereby increase
    27        the risk of developing heart disease, yes.
    28
    29   MR. JUSTICE BELL:   Just pause a moment, please.  Yes.
    30
    31   MS. STEEL:   When you talked earlier in your evidence about the
    32        recommendations and reducing the incidence of
    33        cardiovascular disease, do you know the figures for in
    34        terms of how many people suffer from it and how many people
    35        would be expected to be at less risk, or whatever, as a
    36        result of the changes?
    37        A.   Not off the top of my head.  Recommendations are based
    38        on looking at all of the risk factors and the recognition
    39        that some, if the advice is taken, that some are going to
    40        be much more effective than others.  For example, it is
    41        believed that if people gave up smoking cigarettes this
    42        would have more effect than a diet modification.  If people
    43        ate more fruit and vegetables this might have a more
    44        beneficial effect than, say, reducing fat consumption and
    45        people can make calculations but they are really guesses of
    46        what could happen.  The only way of seeing what can happen
    47        is to carry out long term intervention studies and make
    48        measurements.
    49
    50   Q.   But the purpose of making these recommendations is to 
    51        reduce the numbers of deaths and the number of people 
    52        suffering from heart disease or heart related diseases? 
    53        A.   Yes, it is to reduce mortality.  It is also to reduce
    54        morbidity, people ill, because it costs an awful lot of
    55        money to look after people who are suffering from heart
    56        disease.
    57
    58   Q.   Right.  Can I just briefly ask you about the study that you
    59        commented on.  You said something about one of them being a
    60        piece of work done on 5 subjects which was a very small

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