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Editorial |

Low Risk—and the “No More Than 50%” Myth/Dogma

Jeremiah Stamler, MD
Arch Intern Med. 2007;167(6):537-539. doi:10.1001/archinte.167.6.537.
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Medical myths/dogmas die hard. Researchers creating a new body of knowledge for prevention and control of the coronary heart disease–cardiovascular disease (CHD-CVD) epidemic had to disprove and displace the following successive myths/dogmas (among others):

  • In the early 1950s: severe atherosclerosis is part of normal aging, hence inevitable, and nothing can be done about it.1

  • Then: serum cholesterol level and blood pressure (BP) normally rise with age during adulthood.

  • Normal systolic BP is 100 mm Hg plus your age; normal serum cholesterol level is as much as 300 mg/dL (7.8 mmol/L). (Spare us normalcy!)

  • Most high BP is essential hypertension of unknown cause.

  • Treatment to lower high BP only gets at a symptom (not at the underlying disease) and can do harm by lowering the blood flow to the heart and brain, so therapeutic nihilism and judicious neglect are right.

  • Later: systolic BP of 140 to 159 and diastolic BP of 90 to 104 mm Hg is mild hypertension, modest in its impact on CHD-CVD risks, so pay it no attention.

  • Serum cholesterol level is associated with higher CHD-CVD risks only for persons with levels of 240 to 260 mg/dL (6.2-6.7 mmol/L) and higher.

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