Day 014 - 20 Jul 94 - Page 29


     
     1        A.  Well, these are fatty acids for which there is a
              different requirement.  In other words, if they are not
     2        present, then the body will show specific deficiency
              symptoms, in the same way as if there was absence or
     3        insufficiency of a vitamin or a mineral.
 
     4   Q.   If you turn over to page 44, there is a discussion on
              cardiovascular disease.  It starts, as one might expect,
     5        with atherosclerosis, at 3.4.2?
              A.  Yes.
     6
         Q.   It says, this is halfway down the paragraph:  "The
     7         pathogenesis" -- is that what we mean by the mechanism?
              A.  I would think so, yes.
     8
         Q.  "Pathogenesis of this condition is not clear, but it
     9        appears to involve cholesterol in low density lipoproteins
              (LDL)".  The HDL's are not stigmatized in the same way as
    10        LDL's?
              A.  That is right.  There are several types, but the most
    11        important ones are the LDL's because they are the ones
              that, as it says here, are taken up by the arterial wall
    12        and the HDL's which tend to remove cholesterol.
 
    13   Q.   Then at 3.4.4 there is a passage which says perhaps what
              is obvious, that thrombosis "... is usually the final
    14        event in coronary occlusion".  Then it says at 3.4.4.:
               "Risk factors for atherosclerosis.  The development of
    15        atherosclerosis depends on numerous risk factors both
              genetic and environmental.  Smoking, high blood pressure
    16        and raised serum cholesterol are the major ones,  while
              before the menopause women are relatively protected.
    17        Familial CHD risk is often unassociated with the major
              risk factors. "  Does that mean that even in the absence
    18        of a genetic disposition or pre-disposition you may
              nonetheless, if you eat or smoke the wrong things, expect
    19        to get or expect to increase your risk of heart disease?
              A.  I am not quite clear.
    20
         Q.   It says: "Familial CHD risk is often unassociated with the
    21        major risk factors"?
              A.  Yes.  There are people who suffer from hyper
    22        cholesterolemia, where there is an inbuilt or hereditary
              tendency to have a high cholesterol.
    23
         Q.   Then it says: "Smoking is associated with a dose related
    24        increase in risk of death from CHD, independently of other
              risk factors.  Risk of death from CHD is strongly
    25        correlated with blood pressure.  About 50% of the
              variations CHD risk can be attributed to these known 
    26        environmental risk factors.  Other modulators of risk may 
              include dietary components such as antioxidant vitamins, 
    27        which influence macrophage uptake of LDL, and long chain
              fatty acids which may affect blood clotting".  Then there
    28        is a passage explaining serum cholesterol is a significant
              factor in the assessment of risk?
    29        A.  Yes.
 
    30   Q.   But in 3.4.6 that dietary saturated fatty acids and --
              sorry, there is a relationship between dietary saturated

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