Canibais e Reis

Fonte: Japanese longevity gene found in Europeans (Cinha Daily).

 No artigo recente "Blood Cholesterol as a Good Marker of Health in Japan", que consta do livro "A Balanced Omega-6/Omega-3 Fatty Acid Ratio, Cholesterol and Coronary Heart Disease" (que você pode folhear parcialmente aqui - págs. 63-70), investigadores japoneses da Unv. de Medicina de Tokai, em Isehara, no Japão, autores também do estudo "The Relationship between Total Blood Cholesterol Levels and All-cause Mortality in Fukui City, and Meta-analysis of This Relationship in Japan" que eu já havia discutido aqui, apresentam uma meta-análise dos níveis de CT e de LDL em função da mortalidade total e por várias causas no Japão. Este artigo surge na sequência das novas guidelines japonesas, que passaram de recomendações à base de CT para LDL sem qualquer justificação epidemiológica, facto para o qual os autores alertam. Neste artigo os investigadores fazem notar que o CT, ou mesmo a sua fracção LDL, não representam marcadores de risco fiáveis da mortalidade total. Por outras palavras, a designada hipercolesterolemia não é um factor de risco considerável da mortalidade total no Japão (E também não é no resto do mundo, pois claro!). Na discussão dos seus resultados, abaixo apresentada, os autores constatam que 9.662 homens residentes em Osaka, com 40-79 anos, sem passado de doença do aparelho circulatório e seguidos por 10.7 anos, apresentam maior longevidade precisamente na gama de colesterol "elevado", de 240-280 mg/dl, o chamado "colesterol de risco". De forma similar, nas mulheres foi observada menor mortalidade nos níves mais altos de LDL, o colesterol "mau". A mortalidade de homens e mulheres por infecções respiratórias está também associada a menores níveis de LDL. A mortalidade por acidentes apresenta forma em U para ambos os sexos. A mortalidade por acidente vascular cerebral, o malogrado AVC, é igualmente menor nos níveis superiores de LDL. Toda esta evidência epidemiológica (que não é uma especificidade do Japão, mas totalmente universal, porque também não faltam aos europeus o gene da longevidade, a meu ver aniquila por completo a Hipótese Lipídica), naturalmente coloca as maiores dúvidas a estes investigadores, que questionam o facto das novas guidelines japonesas estarem a propor uma situação completamente paradoxal: as pessoas com maior longevidade devem ser sujeitas a tratamentos para baixar o colesterol a níveis "saudáveis", os que supostamente minimizam a mortalidade cardiovascular. Mas qual a lógica de estar a "tratar" os indivíduos que já possuem a maior longevidade? Para lhes reduzir apenas uma sub-causa de mortalidade? (Este é o grande problema da especialização, em particular da Cardiologia moderna: perde-se a visão do conjunto, esquecendo-se que a saúde é TOTALMENTE multi-factorial). Os indivíduos "dislipidémicos" japoneses com níveis de colesterol acima de 240 mg/dl, na opinião destes investigadores, naturalmente não devem ser considerados "doentes". Ou melhor dizendo, não deverão ser transformados em doentes por causa de um mito moderno, o de que os níveis de colesterol (designadamente de LDL) estarão, decisivamente, relacionados com doença cardiovascular. Se você investigar a fundo (comece por aqui e aqui), vai ver que não existe ciência sólida para suportar esta ideia, mas antes um longo histórico de interesses políticos, farmacêuticos, médicos e económicos, suportado por muita pseudo-ciência e ingenuidade humana. Portanto, tudo coisas nada relacionadas com a real promoção da saúde ou da longevidade humanas!
 

Blood Cholesterol as a Good Marker of Health in Japan

Mortality from coronary heart disease (CHD) is only one fourteenth [1] to one fifteenth [2] of the total deaths in Japan, which is totally different from Western countries. Moreover, it appears that mortality stratified according to age and sex from acute myocardial infarction and other types of ischemic heart disease has been decreasing over the past decades in Japan [3]. High blood cholesterol levels are a well-known risk factor for CHD. The majority of Japanese researchers believe that the lower the cholesterol level one has the better [4]. However, if all-cause mortality is considered, higher cholesterol levels may not be a formidable risk factor in Japan. Although the number of studies is limited, all the Japanese epidemiological studies on cholesterol and all-cause mortality indicate that hypercholesterolemia is not a considerable risk factor for all-cause mortality [5]. In order to clarify the relationship between blood total cholesterol levels and all-cause mortality in Japan, we meta-analyzed several Japanese epidemiological studies that contained total cholesterol levels and all-cause mortality. In 2007, Japan Atherosclerosis Society (JAS) published the latest version of its guidelines [6]. In the guidelines, JAS changed the former diagnostic criteria of hypercholesterolemia (total cholesterol: 220 mg/dl, 5.7 mm) described in the 2004 version [4] to 140 mg/dl (3.6 mm) of low-density lipoprotein (LDL) cholesterol, and JAS no longer used total cholesterol levels in any tables related to the diagnosis or treatment criteria in the dyslipidemia sections [6]. However, the guidelines utilized NIPPON DATA 80 [7, 8], which did not contain any LDL cholesterol data at all, as the main evidence for their guidelines [6]. This is hard to understand. JAS should have had some epidemiological LDL data for publication of any LDL cholesterol level criteria. Here, we report the relationship between LDL cholesterol levels and mortality in Isehara, Kanagawa Prefecture, Japan.

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RESULTS

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DISCUSSION

As shown in figure 1, low cholesterol levels were a significant risk factor of all-cause mortality irrespective of sex. Four reports were excluded from the present meta-analysis (table 1). Some important points of those excluded studies are described in the following paragraph. All-cause mortality of Osaka residents of 40–79 years of age without a past history of stroke or CHD was investigated for a period of 10.7 years [11]. Those subjects who died during the first 2 years of observation were excluded. In males, the cholesterol levels of 240–280 mg/dl (6.2–7.3 mm) were safest in terms of all-cause mortality, and in females cholesterol levels did not seem to matter except for those whose levels were below 160 mg/dl (4.1 mm), where the all-cause mortality was highest. In another set of NIPPON DATA 80 extended to 17.3 years [7], the RR of mortality in the male 240–259 mg/dl (6.2–6.7 mm) group was second lowest only to the 160–179 mg/dl (4.1–4.6 mm) group. The risk in the 240–259 mg/dl (6.2–6.7 mm) group was lowest in women. Kanari [13] followed 1,877 men and 3,338 women in Fukushima Prefecture for 10 years and found that the highest quartile of cholesterol levels in both sexes had the lowest mortality. Moreover, the lowest cholesterol quartile in men had a significantly higher mortality than the highest cholesterol quartile (but not found in women). Ida et al. [14] followed 2,432 men and 3.379 women for 12 years. There were no significant differences in all-cause mortality among groups with different cholesterol levels. Judging from the excluded data shown above, it is likely that inclusion of those studies in the present study (although it was not technically possible to do so) would not have changed the results to any appreciable extent. However, there seems to be a trend that all-cause mortality becomes flatter across the cholesterol levels with longer observation periods. The trends of all-cause mortality across LDL cholesterol levels in men and women (fig. 2 and 3, respectively) were more or less similar to the results of our meta-analysis.

There were a few interesting points in figures 2 and 3. Mortality from CHD in women was lowest in the highest LDL cholesterol group; mortality from respiratory diseases was lowest in the highest LDL cholesterol group in both men and women; mortality from trauma had U-shaped curves in both men and women. Also, mortality from cerebrovascular diseases might become low with increasing LDL cholesterol levels. These points are now under careful investigation. According to the new JAS guidelines [6], if the LDL cholesterol levels of those subjects having one or two risk factors are over 140 mg/dl (3.6 mm) [corresponding to total cholesterol of 220 mg/dl (5.7 mm)], treatment with medicines is recommended in the case that advice to change the lifestyle to decrease LDL cholesterol levels does not work. Switching to LDL cholesterol from total cholesterol in the Guidelines might be good because hypercholesterolemia due to high HDL cholesterol levels can be excluded. At the same time, this switching is very confusing for medical practitioners who have long been used to total cholesterol levels. There have been no epidemiological data about the relationship between LDL cholesterol and deaths in Japan except for our Isehara Study. Considering the present meta-analysis and Isehara Study, JAS Guidelines [6] appear to face a serious paradox. If a doctor prescribes cholesterol-lowering medicines to subjects with total cholesterol levels of ≥220 mg/dl or LDL cholesterol levels ≥140 mg/dl, the doctor is prescribing medicines to those with the least (or almost the least) chance to die (fig. 1–3). Those whose risk of death is smallest probably have the least need for medication. Japanese subjects with cholesterol levels of ≥240 mg/dl (≥6.2 mm) should not be regarded as hypercholesterolemic or dyslipidemic because they are in the safest ranges in terms of all-cause mortality except for some genetic disorders like FH cases. Very low incidence of CHD in Japan (fig. 2 and 3) made this possible, and one of the reasons for the very low CHD mortality is probably a very high intake of ω−3 fatty acids [18]. Treatment of hypercholesterolemia should be carefully limited to some genetic disorders like familial hypercholesterolemia in the case of primary prevention.

 

Source: Blood cholesterol as a good marker of health in Japan.